Blastoff Adult Care Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

BLASTOFF ADULT CARE HOME

Practice address

1114 Hope Mills Rd
Fayetteville, NC 28304-4247

Phone

(910) 303-1702

NPI assigned

Apr 10, 2025

Organization subpart

No

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

Authorized official

Name

Kim N Landry, OWNER

Title

Adminstrator

Phone

(910) 303-1702

Specialties & licenses 1

Addresses

Other names 1

• Weekend Blast Christian Learning Center Former legal business name

Tax ID family

Blastoff Adult Care Home3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Blast-Off Day Program

  • In Home Supportive Care Agency
  • Fayetteville, NC
  • NPI 1023983806
  NPD tax ID
• Blastoff Adult Care Home

  • Adult Care Home Facility
  • Fayetteville, NC
  • NPI 1265223143
  NPD tax ID

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

{
    "created_epoch": "1744243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744243200000",
    "number": "1982499158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 HOPE MILLS RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044247",
            "telephone_number": "910-303-1702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1114 HOPE MILLS RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044247",
            "telephone_number": "910-303-1702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLASTOFF ADULT CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-10",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A",
        "authorized_official_last_name": "LANDRY",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "ADMINSTRATOR",
        "authorized_official_telephone_number": "910-303-1702",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Weekend Blast Christian Learning Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Deidra Blanks, M.D.
• Sheila Lane Blanks, FNP
• Benjamin Blaschke, PA-C
• Blast-Off Day Program
• Blastoff Adult Care Home
• BLC Group Home LLC
• Bless a Rider LLC
• Blessed Open Arms
• Audrey Blevins
• Evette Lemille Blevins

• Adult Care Home Facility in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2025; 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.