NPIMap

Organization Active NPI

Centennial Housing & Community Services Corporation

Doing business as Washington Regional Medical Center

  • Critical Access Hospital
  • Plymouth, NC
National Provider Identifier
1972119782
Registry record updated Jun 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
CENTENNIAL HOUSING & COMMUNITY SERVICES CORPORATION
Doing business as
Washington Regional Medical Center
Practice address
958 US Highway 64 E
Plymouth, NC 27962-9216
Phone
(252) 793-4135
Fax
(252) 793-7740
NPI assigned
Sep 17, 2020
Last updated
Jun 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2022

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X Primary

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 1

  • Washington Regional Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972119782. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Dec 13, 2018 in CA
Enrollment address
958 US Highway 64 E
Plymouth, NC 27962-9216
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Washington County Hosp IncCCN 341314 · All quality measures
Type
Critical Access Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Centennial Housing Communi4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

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

500 N Central Expy
Ste 175
Plano, TX 75074

Ownership & related parties

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 DirectorBoard Member May 5, 2020
Frank IV Avignone Individual 5% Or Greater Direct Ownership InterestChief Executive Officer May 5, 2020
Corporate OfficerPresident May 5, 2020
Corporate Director May 5, 2020
W-2 Managing Employee May 5, 2020

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

Affiliated clinicians 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655424000000",
    "number": "1972119782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 707",
            "city": "PLYMOUTH",
            "state": "NC",
            "postal_code": "279620707",
            "telephone_number": "252-793-4135",
            "fax_number": "252-793-7740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "958 US HIGHWAY 64 E",
            "city": "PLYMOUTH",
            "state": "NC",
            "postal_code": "279629216",
            "telephone_number": "252-793-4135",
            "fax_number": "252-793-7740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL HOUSING & COMMUNITY SERVICES CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-17",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A",
        "authorized_official_last_name": "AVIGNONE",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-502-9624",
        "authorized_official_name_suffix": "IV"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Washington Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Washington Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plymouth, NC

Sources for this page

Verify at the official NPI Registry.