NPIMap

Organization Active NPI

Mizpah Healthcare, Inc

  • Assisted Living Facility
  • Marion, NC
National Provider Identifier
1972638245
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
HAL-059-008 Issued in NC
Legal business name
MIZPAH HEALTHCARE, INC
Practice address
63 Lakeview Dr N
Marion, NC 28752-8896
Phone
(828) 652-3038
NPI assigned
Feb 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Cathy Childrey, R.N.
Title
Ceo
Phone
(910) 848-0694

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X HAL-059-008 NC Primary

Addresses

Primary practice location

63 Lakeview Dr N
Marion, NC 28752-8896

Mailing address

PO Box 1796
Southern Pines, NC 28388-1796
Phone (910) 848-0694

Other identifiers 1

IdentifierTypeStateIssuer
7802946MedicaidNC

Other names 1

  • Lake James Lodge Assisted Living Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Arbor Care Assisted Living4 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.

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972638245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1796",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283881796",
            "telephone_number": "910-848-0694",
            "fax_number": "910-848-0456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 LAKEVIEW DR N",
            "city": "MARION",
            "state": "NC",
            "postal_code": "287528896",
            "telephone_number": "828-652-3038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIZPAH HEALTHCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHILDREY",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-848-0694",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL-059-008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7802946",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake James Lodge Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marion, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.