NPIMap

Organization Active NPI

Mildred Blackwell

  • Adult Care Home Facility
  • Yanceyville, NC
National Provider Identifier
1992025316
Registry record updated Jun 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
Legal business name
MILDRED BLACKWELL
Practice address
3592 Marshall Graves Rd
Yanceyville, NC 27379-8630
Phone
(336) 421-0646
NPI assigned
Jun 8, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2010

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

Authorized official

Name
Miss Mildred Blackwell
Title
Owner
Phone
(336) 421-0646

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X Primary

Addresses

Primary practice location

3592 Marshall Graves Rd
Yanceyville, NC 27379-8630

Mailing address

203 N Main St
Suite 315
Roxboro, NC 27573-5343
Phone (336) 421-0646

Other names 1

  • Dogwood Forest Family Care Two Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dogwood Forest Family Care Two2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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": "1275955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275955200000",
    "number": "1992025316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 N MAIN ST",
            "address_2": "SUITE 315",
            "city": "ROXBORO",
            "state": "NC",
            "postal_code": "275735343",
            "telephone_number": "336-421-0646",
            "fax_number": "336-599-4349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3592 MARSHALL GRAVES RD",
            "city": "YANCEYVILLE",
            "state": "NC",
            "postal_code": "273798630",
            "telephone_number": "336-421-0646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILDRED BLACKWELL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-08",
        "last_updated": "2010-06-08",
        "status": "A",
        "authorized_official_last_name": "BLACKWELL",
        "authorized_official_first_name": "MILDRED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-421-0646",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dogwood Forest Family Care Two",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yanceyville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2010; 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.