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Centennial Housing & Community Services Corporation

Organization Active NPI Critical Access Hospital · Plymouth, NC

NPI 1972119782 · NPPES record last updated Jun 17, 2022

Key facts

NPI
1972119782
Entity type
Organization (NPI type 2)
Primary specialty
Critical Access Hospital 282NC0060X
Legal business name
CENTENNIAL HOUSING & COMMUNITY SERVICES CORPORATION
Practice address
958 US Highway 64 E
Plymouth, NC 27962-9216
Phone
(252) 793-4135
Fax
(252) 793-7740
NPI assigned
Sep 17, 2020
Organization subpart
No

Authorized official

Name
Frank T Avignone IV
Title
Ceo
Phone
(214) 502-9624

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 3

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

Facilities connected through Provider of Services related, parent or unit certification numbers.

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

Affiliated clinicians 17

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Medicare Care Compare: Hospital

Listed as
Washington County Hosp Inc CCN 341314
Type
Critical Access Hospitals
Ownership
Proprietary
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NC

Hospital certification: CCN 341314

Legal name
CENTENNIAL HOUSING & COMMUNITY SERVICES CORPORATION
Doing business as
WASHINGTON REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 1, 2002
Last certification
Jul 11, 2018
Beds
49 (25 certified)
Ownership / control type
Private (for profit)
Most recent change of ownership
Jun 1, 2007 (1 total)
Organization structure
Corporation · Non-profit
Incorporated
Dec 13, 2018 in CA
Enrollment address
958 US Highway 64 E
Plymouth, NC 27962-9216
Main/Primary Hospital Location

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Todd Mobley
Individual 		Corporate Director
Board Member		 May 5, 2020
Frank IV Avignone
Individual 		5% Or Greater Direct Ownership Interest
Chief Executive Officer		 May 5, 2020
Corporate Officer
President		 May 5, 2020
Corporate Director May 5, 2020
W-2 Managing Employee May 5, 2020

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20201110000289 NC Part a Provider - Critical Access Hospital 3779993837 Receives reassigned benefits from 2 practitioners
Practice locations: Plymouth, NC

National Provider Directory

Tax ID family
Centennial Housing Communi (4 organizations share this tax ID)

Locations

758 US Highway 64 E
Plymouth, NC 27962

795 US Highway 64 E
Plymouth, NC 27962
Phone (252) 793-2103

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X Yes

Addresses

Primary practice location

958 US Highway 64 E
Plymouth, NC 27962-9216

Mailing address

PO Box 707
Plymouth, NC 27962-0707
Phone (252) 793-4135

Other names

  • Washington Regional Medical Center Doing business as

Other providers in Plymouth, NC

All providers in Plymouth, NC · Critical Access Hospital in North Carolina

Sources for this page

Verify at the official NPI Registry.