Elkin Retirement Community, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL-086-013 Issued in NC

Legal business name

ELKIN RETIREMENT COMMUNITY, LLC

Practice address

500 Johnson Ridge Rd
Elkin, NC 28621-2420

Phone

(336) 835-6672

NPI assigned

Apr 27, 2009

Last updated

Jun 13, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Dean Wilson

Title

Managing Partner

Phone

(336) 495-2700

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1240790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371081600000",
    "number": "1952545592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 814",
            "city": "RANDLEMAN",
            "state": "NC",
            "postal_code": "273170814",
            "telephone_number": "336-495-2700",
            "fax_number": "336-495-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 JOHNSON RIDGE RD",
            "city": "ELKIN",
            "state": "NC",
            "postal_code": "286212420",
            "telephone_number": "336-835-6672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELKIN RETIREMENT COMMUNITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-27",
        "last_updated": "2013-06-13",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "336-495-2700"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL-086-013",
            "primary": true
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7806495",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Woodruff Word Faulk Jr., MD

• Assisted Living Facility in Elkin, NC
• Providers in Elkin, NC by specialty
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2013; 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.