Lsa Elms at Tanglewood, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL034085 Issued in NC

Legal business name

LSA ELMS AT TANGLEWOOD, INC.

Practice address

3750 Harper Rd
Clemmons, NC 27012-8682

Phone

(336) 766-2131

Fax

(336) 766-2160

NPI assigned

Jan 2, 2009

Organization subpart

Yes

Parent organization

LUTHERAN SERVICES FOR THE AGINGAs reported in NPPES

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

Authorized official

Name

Mrs. Deborah Ann Mathis

Title

Coo

Phone

(704) 637-2870

Specialties & licenses 2

Addresses

Other names 1

• Elms at Tanglewood Doing business as

Locations

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

{
    "created_epoch": "1230854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230854400000",
    "number": "1962648543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3750 HARPER RD",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128682",
            "telephone_number": "336-766-2131",
            "fax_number": "336-766-2160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 HARPER RD",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128682",
            "telephone_number": "336-766-2131",
            "fax_number": "336-766-2160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LSA ELMS AT TANGLEWOOD, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUTHERAN SERVICES FOR THE AGING",
        "enumeration_date": "2009-01-02",
        "last_updated": "2009-01-02",
        "status": "A",
        "authorized_official_last_name": "MATHIS",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "704-637-2870",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL034085",
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "NC",
            "license": "HAL034085",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elms at Tanglewood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anna Michelle Licari, PHARMD
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• Bethany Rena Low, APRN
• Martha V Low, MA LPC
• John T Lundquist, C.PED.
• Jamie Lauren Lunsford
• Lutheran Family Services in the Carolinas
• Lutheran Home - Forsyth County, Inc.
• Allison Douglas Lyerly, OD

• Assisted Living Facility in Clemmons, NC
• Providers in Clemmons, 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 Jan 2, 2009; 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.