PREMIER OPERATING COUNTRYSIDE VILLAGE, LLC (NPI# 1467808329) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467808329 |
| Entity Type | Organization |
| Organization Name | PREMIER OPERATING COUNTRYSIDE VILLAGE, LLC |
| Practice Address |
5383 Us Highway 117 N Pikeville NC 27863-9443 |
| Practice Telephone | 9192426369 |
| Practice Fax Number | 9192429884 |
| Mailing Telephone | 9192426369 |
| Mailing Fax Number | 9192429884 |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2016-05-10 |
| Authorized Official Name | ROBERT BORSODY (PRINCIPAL) |
| Authorized Official Telephone | 2127390794 |
| Is Organization Subpart | Y |
| Parent Organization Name | PREMIER SENIOR LIVING, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
NC | Nursing & Custodial Care Facilities |
| Street Address |
5383 US HIGHWAY 117 N |
| City | PIKEVILLE |
| State | NC |
| Zip Code | 27863-9443 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295029791 | Countryside Village LLC | Assisted Living Facility | 5383 Us Highway 117 N, Pikeville, NC 27863-9443 | 2011-06-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003299561 | Chrishaunda Lakeish Vick | Nurse Practitioner | 4680 Us-177, Pikeville, NC 27863 | 2015-07-02 |
| 1619208071 | Faithful Family Care | Assisted Living Facility | 103 Se Railroad St, Pikeville, NC 27863 | 2010-01-26 |
| 1144375874 | Thigpen Pharmacy, Inc | Durable Medical Equipment & Medical Supplies | 107-111 Nw Railroad St, Pikeville, NC 27863 | 2007-01-24 |
| 1437206448 | Margaret Mooring Evans | Nurse Practitioner | 5413 Us 117 N, Eastern Medical Associates, Pikeville, NC 27863 | 2007-01-04 |
| 1013000124 | Food Lion LLC | Durable Medical Equipment & Medical Supplies | 4700 Us Highway 117 North, Pikeville, NC 27863 | 2006-10-02 |
| 1649895442 | Gaynelle Bolling | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 102 Mandarin Dr, Pikeville, NC 27863-0020 | 2020-06-08 |
| 1184829038 | Countryside Living | Assisted Living Facility | 5383 Us 117 North, Pikeville, NC 27863-0335 | 2007-06-20 |
| 1740436989 | C&e Assisted Living, Inc | Assisted Living Facility | 109 Southeast Railroad Street, Pikeville, NC 27863-0428 | 2008-08-07 |
| 1710221247 | Staci Lynne Short | Physical Therapist | 117 Oak Summit Dr, Pikeville, NC 27863-8116 | 2012-11-21 |
| 1174867618 | S.t.a.n.d...ing, Inc | Community/Behavioral Health | 206 S Goldsboro Rd, Pikeville, NC 27863-8335 | 2012-11-21 |
| Find all providers in zip 27863 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336271691 | Krystals House, LLC | Custodial Care Facility | 83 White Horse Rd, Pikeville, NC 27863-8365 | 2007-03-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578162061 | Lewis E Williams | Custodial Care Facility | 1640 Bridgedale Dr, Rocky Mount, NC 27803-1604 | 2020-10-26 |
| 1861008583 | Arbor Landing At Hampstead LLC | Custodial Care Facility | 13937 Us Highway 17, Hampstead, NC 28443-4041 | 2020-09-17 |
| 1124645544 | Charlotte Sp Senior Housing Opco, LLC | Custodial Care Facility | 6041 Piedmont Row Drive, Charlotte, NC 28208 | 2020-07-01 |
| 1740804111 | Happy Hearts Group Home | Custodial Care Facility | 6255 Burlington Rd, Gibsonville, NC 27249-8783 | 2020-06-02 |
| 1730703422 | Graham 4 Enterprises | Custodial Care Facility | 3006 W Sedgefield Dr, Greensboro, NC 27407-7313 | 2020-05-29 |
| 1477177111 | C&s Adult Care LLC, Dba Deal Care Inn | Custodial Care Facility | 1075 Deal Rd, Mooresville, NC 28115-6719 | 2020-05-28 |
| 1114554516 | Cassandra Davis | Custodial Care Facility | 131 Huntington Rd, Louisburg, NC 27549 | 2020-03-25 |
| 1356975767 | Cornerstone Community Service | Custodial Care Facility | 2220 Southgate St, Durham, NC 27703-2102 | 2020-02-24 |
| 1477184653 | Rose Vista Assisted Living, LLC | Custodial Care Facility | 2130 Rose Vista Rd, Kinston, NC 28504-8230 | 2020-01-28 |
| 1104456011 | Regina Williams | Custodial Care Facility | 511 Tansy Drive, Charlotte, NC 28214 | 2020-01-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.