CLEMMONS ASSISTED LIVING LLC NPI 1649355439

NPI Information

  • NPI: 1649355439
  • Provider Name: CLEMMONS ASSISTED LIVING LLC
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • Doing Business As: CLEMMONS VILLAGE II
  • CLIA Number: 34D2027875
  • Address: 6441 HOLDER RD
    CLEMMONS, NC
    ZIP 27012
  • Phone: (336) 778-8548

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NPI Details

CLEMMONS ASSISTED LIVING LLC is an assisted living facility in Clemmons, NC. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. CLEMMONS ASSISTED LIVING LLC NPI is 1649355439. The provider is registered as an organization entity type.
The provider Is Doing Business As Clemmons Village Ii.

The provider's business location address is:

6441 HOLDER RD
CLEMMONS, NC
ZIP 27012-207
Phone: (336) 778-8548
Fax: (336) 778-8875

The provider's authorized official is Aldo Baccala .
The authorized official title is Owner / Manager and has the following contact phone number (707) 778-6713.

The CLIA number assigned to this NPI record is 34D2027875 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/27/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityHAL-034-062NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
17804691MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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