LIFE ST. JOSEPH OF THE PINES, INC. (NPI# 1750692620) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750692620 |
| Entity Type | Organization |
| Organization Name | LIFE ST. JOSEPH OF THE PINES, INC. |
| Practice Address |
4900 Raeford Rd Fayetteville NC 28304-3142 |
| Practice Telephone | 9104834911 |
| Mailing Telephone | 9104834911 |
| Mailing Fax Number | 9104834930 |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2013-02-08 |
| Authorized Official Name | MR. ROBERT LAWRENCE DICKSON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9104297255 |
| Is Organization Subpart | Y |
| Parent Organization Name | ST JOSEPH OF THE PINES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251T00000X | PACE Provider Organization | PENDING | NC | Agencies |
| Street Address |
4900 RAEFORD RD |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28304-3142 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023198504 | Kimberly Dawn Bell | Nurse Practitioner | 4900 Raeford Rd, Fayetteville, NC 28304-3142 | 2006-10-17 |
| 1528539327 | Ann Marie Anderson | Nurse Practitioner | 4900 Raeford Rd, Fayetteville, NC 28304-3142 | 2018-12-06 |
| 1447514997 | Malinda Marie Kennison | Physical Therapist | 4900 Raeford Rd, Fayetteville, NC 28304-3142 | 2012-06-29 |
| 1063705119 | Tara R Jones | Family Medicine | 4900 Raeford Rd, Fayetteville, NC 28304-3142 | 2011-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301061 | Coast To Coast Bilingual Counseling | Social Worker | 910 Hope Mills Road, Fayetteville, NC 28304 | 2019-11-20 |
| 1811530561 | Frances L. Hurst | Technician | 6732 Carloway Dr, Fayetteville, NC 28304 | 2019-10-25 |
| 1538717764 | Rose Mary A O'conner | Technician | 3530 Madison Ave, Fayetteville, NC 28304 | 2019-08-30 |
| 1932756087 | Sally Frances Jones | Technician | 2053 Mango Circle, Fayetteville, NC 28304 | 2019-08-23 |
| 1326528803 | Jeneen Yvette Townsend | Counselor | 2671 Adams Lake Dr Apt F, Fayetteville, NC 28304 | 2018-08-15 |
| 1780179580 | Ma Cornelia Villavicencio Leano | Nurse Practitioner | 3081 Stone Carriage Cir Apt Z, Fayetteville, NC 28304 | 2018-06-25 |
| 1861986267 | Pediatric After Hours Care of Fayetteville | Pediatrics | 556 Sandhurst Drive, Fayetteville, NC 28304 | 2018-06-19 |
| 1700386133 | Good Night Medical of Ohio, LLC | Durable Medical Equipment & Medical Supplies | 405 Owen Dr Ste 202, Fayetteville, NC 28304 | 2018-02-12 |
| 1003321365 | Valleygate Dental Surgery Center of Fayetteville, LLC | Dentist | 2038 Litho Place, Fayetteville, NC 28304 | 2017-12-08 |
| 1871004663 | The Salt Project | Marriage & Family Therapist | 1611-b Owen Dr., Fayetteville, NC 28304 | 2017-10-19 |
| Find all providers in zip 28304 | ||||
| Taxonomy Code | 251T00000X |
| Grouping | Agencies |
| Classification | PACE Provider Organization |
| A PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated managed care benefits for the frail elderly which include comprehensive medical and social services). The following characteristics also apply to a PACE organization. It must: have a governing board that includes community representation; be able to provide complete PACE services regardless of frequency or duration of services; have a physical site to provide adult day services; have a defined service area; have safeguards against conflict of interest; have demonstrated fiscal soundness and have a formal Participant Bill of Rights. |
| Notes: Source: Centers for Medicare and Medicaid, PACE Fact Sheet http://www.cms.hhs.gov/PACE/Downloads/PACEFactSheet.pdf [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417490202 | Angels At Heart Assisted Living | PACE Provider Organization | 140 Kent Road, Salisbury, NC 28147 | 2016-11-28 |
| 1376986679 | Piedmont Health Services, Inc | PACE Provider Organization | 220 Chatham Business Dr, Pittsboro, NC 27312-5603 | 2013-04-17 |
| 1730439571 | Pace of The Southern Piedmont | PACE Provider Organization | 6133 The Plaza, Charlotte, NC 28215 | 2012-09-19 |
| 1093075905 | Carolina Seniorcare | PACE Provider Organization | 802 E Center St, Lexington, NC 27292-4402 | 2012-05-24 |
| 1114246956 | Mayo's Loving Care | PACE Provider Organization | 105 Krista Ln, Rocky Mount, NC 27803-5228 | 2010-05-19 |
| 1447485396 | Lift Day Activity Center | PACE Provider Organization | 701 E Young Street, Rolesville, NC 27571 | 2009-05-21 |
| 1932302361 | Dunn's House of Love and Devoted Care, Inc. | PACE Provider Organization | 1846 E Trail Dr Se, 1812 Birchwood Dr., Wilson, NC 27893-8732 | 2007-06-05 |
| 1427692680 | Carepartners Rehabilitation Hospital, Lllp | PACE Provider Organization | 286 Overlook Rd, Asheville, NC 28803-3317 | 2019-10-31 |
| 1063977338 | Ricas Angels Home Health Care LLC | PACE Provider Organization | 221 N Elm St, Lumberton, NC 28358-5647 | 2019-01-31 |
| 1659898906 | Mission Hospital, Inc | PACE Provider Organization | 286 Overlook Rd, Asheville, NC 28803-3317 | 2017-08-28 |
| Find all providers with the same taxonomy | ||||
| City | FAYETTEVILLE |
| Zip Code | 28304 |
Please comment or provide details below to improve the information on LIFE ST. JOSEPH OF THE PINES, INC..
| 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.