NPIMap

Organization Active NPI

Kellams Family Care Home LLC

  • Assisted Living Facility
  • Reidsville, NC
National Provider Identifier
1952786063
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
FCL079098 Issued in NC
Legal business name
KELLAMS FAMILY CARE HOME LLC
Doing business as
KELLAMS FAMILY CARE HOME
Practice address
109 Roanoke St
Reidsville, NC 27320-3023
Phone
(336) 637-8292
Fax
(336) 361-3194
NPI assigned
Jul 30, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Authorized official

Name
Mary Keesee Thomas
Title
Administrator
Phone
(336) 613-5065

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X FCL079098 NC Primary

Addresses

Primary practice location

109 Roanoke St
Reidsville, NC 27320-3023

Mailing address

505 Staples St
Reidsville, NC 27320-3034
Phone (336) 342-1388

Other names 1

  • KELLAMS FAMILY CARE HOME Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kellams Family Care Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1438214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1952786063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 STAPLES ST",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273203034",
            "telephone_number": "336-342-1388",
            "fax_number": "336-361-3194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 ROANOKE ST",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273203023",
            "telephone_number": "336-637-8292",
            "fax_number": "336-361-3194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLAMS FAMILY CARE HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-30",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-08",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "KEESEE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "336-613-5065"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "FCL079098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KELLAMS FAMILY CARE HOME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reidsville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.