Creekside Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL-026-059 Issued in NC

Legal business name

CREEKSIDE ASSISTED LIVING LLC

Practice address

1124 Cedar Creek Rd
Fayetteville, NC 28312-6544

Phone

(910) 323-8212

Fax

(910) 323-2159

NPI assigned

Oct 5, 2011

Organization subpart

No

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

Authorized official

Name

Riley S Evans

Title

Managing Member

Phone

(910) 648-6887

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1317772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317772800000",
    "number": "1982988226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 847",
            "city": "CLARKTON",
            "state": "NC",
            "postal_code": "284330847",
            "telephone_number": "910-648-6887",
            "fax_number": "910-648-6888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 CEDAR CREEK RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283126544",
            "telephone_number": "910-323-8212",
            "fax_number": "910-323-2159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-05",
        "last_updated": "2011-10-05",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "RILEY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "910-648-6887"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL-026-059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; 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.