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LUTHERAN FAMILY SERVICES IN THE CAROLINAS NPI 1881740298


NPI Information

NPI: 1881740298
Provider Name: LUTHERAN FAMILY SERVICES IN THE CAROLINAS

Doing Business As: WILSON SMITH COTTAGE

Classification: Intermediate Care Facility, Mentally Retarded - 315P00000X
Entity Type: Organization

CLIA Number: 34D2124587

Address:
185 MARTINDALE RD
WINSTON SALEM, NC
ZIP 27107
Phone: (336) 785-3813
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LUTHERAN FAMILY SERVICES IN THE CAROLINAS is an intermediate care facility mentally retarded in Winston Salem, NC. The provider is (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. LUTHERAN FAMILY SERVICES IN THE CAROLINAS NPI is 1881740298. The provider is registered as an organization entity type.
The provider Is Doing Business As Wilson Smith Cottage.

The provider's business location address is:

185 MARTINDALE RD
WINSTON SALEM, NC
ZIP 27107-705
Phone: (336) 785-3813

The provider's authorized official is Kirby Nickerson .
The authorized official title is Chief Financial Officer and has the following contact phone number (704) 754-8228.

The CLIA number assigned to this NPI record is 34D2124587 - intermediate care facility/individuals with intellectual disability with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/26/2007 and was last updated on 6/26/2017.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251S00000XCommunity/Behavioral HealthNo
2320600000XResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesMHL-034-045NORTH CAROLINANo
3315P00000XIntermediate Care Facility, Mentally RetardedMHL034045NORTH 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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
13406387MEDICAIDNORTH 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: 11/14/2023

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