NPIMap

Organization Active NPI

Willow Manor

  • Adult Care Home Facility
  • Chocowinity, NC
National Provider Identifier
1972999571
Registry record updated Apr 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
HAL-007-020 Issued in NC
Legal business name
WILLOW MANOR
Practice address
4288 US Highway 17 S
Chocowinity, NC 27817-8434
Phone
(252) 946-2604
NPI assigned
Apr 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2015

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

Authorized official

Name
Courtney Blount
Title
Owner
Phone
(252) 402-5317

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X HAL-007-020 NC Primary

Addresses

Primary practice location

4288 US Highway 17 S
Chocowinity, NC 27817-8434

Mailing address

1220 Pamlico St
Washington, NC 27889-3821
Phone (252) 402-5317

National Provider Directory

National Provider Directory
Tax ID family
Hertford Manor4 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": "1428537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428537600000",
    "number": "1972999571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 PAMLICO ST",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278893821",
            "telephone_number": "252-402-5317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4288 US HIGHWAY 17 S",
            "city": "CHOCOWINITY",
            "state": "NC",
            "postal_code": "278178434",
            "telephone_number": "252-946-2604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-09",
        "last_updated": "2015-04-09",
        "status": "A",
        "authorized_official_last_name": "BLOUNT",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-402-5317"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "HAL-007-020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chocowinity, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2015; 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.