Emma Lucille Garvin, ADMINISTRATOR

Primary specialty

Mental Illness Intermediate Care FacilityTaxonomy code 310500000X

License

MHL 034-190 Issued in NC

Practice address

4527 Country Club Rd
Winston Salem, NC 27104-3517

Phone

(336) 765-8460

Fax

(336) 724-9674

NPI assigned

Mar 20, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1922123892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1161 EDENWOOD DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036114",
            "telephone_number": "336-682-5870",
            "fax_number": "336-724-9674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4527 COUNTRY CLUB RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271043517",
            "telephone_number": "336-765-8460",
            "fax_number": "336-724-9674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARVIN",
        "first_name": "EMMA",
        "middle_name": "LUCILLE",
        "name_prefix": "Mrs.",
        "credential": "ADMINISTRATOR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "NC",
            "license": "MHL 034-190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805234",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sherita Garris
• Michael S. Garrison, MD
• Raymond Sloan Garrison Jr., D.D.S.
• Danielle Marie Garten, PA-C
• Katie Gartland
• Shana Gary, MSW, LCSWA
• Hannah Garza
• Laura Reich Gaskill, NP
• Angela Marie Gaskin
• Anna Whitley Gaskin, PA

• Mental Illness Intermediate Care Facility in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Mental Illness Intermediate Care Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.