IREDELL MEMORIAL HOSP SNF ICF (NPI# 1821284761) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821284761 |
| Entity Type | Organization |
| Organization Name | IREDELL MEMORIAL HOSP SNF ICF |
| Practice Address |
557 Brookdale Drive Statesville NC 28677-4107 |
| Practice Telephone | 7048735661 |
| Mailing Telephone | 7048735661 |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2007-09-24 |
| Authorized Official Name | MR. ED RUSH (PRESIDENT) |
| Authorized Official Telephone | 7048735661 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | H0164 | NC | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 3496054 | 05 |
| Street Address |
557 BROOKDALE DRIVE |
| City | STATESVILLE |
| State | NC |
| Zip Code | 28677-4107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134109556 | Imh Professional Er | General Acute Care Hospital | 557 Brookdale Drive, Statesville, NC 28677 | 2006-01-20 |
| 1235449125 | Optimed Hospitalists, Pllc | Hospitalist | 557 Brookdale Drive, Statesville, NC 28677-4107 | 2010-10-14 |
| 1366778383 | Katherine Hill Long | Nurse Anesthetist, Certified Registered | 557 Brookdale Drive, Statesville, NC 28677 | 2009-10-27 |
| 1649416462 | Toni Fortner | Nurse Anesthetist, Certified Registered | 557 Brookdale Drive, Statesville, NC 28677 | 2008-12-29 |
| 1679719546 | Ronald Butler | Nurse Anesthetist, Certified Registered | 557 Brookdale Drive, Statesville, NC 28677 | 2008-12-26 |
| 1750547626 | John Brzykcy | Physical Therapist | 557 Brookdale Drive, Statesville, NC 28677-0000 | 2008-07-31 |
| 1376709410 | Darren Smith | Physical Therapist | 557 Brookdale Drive, Statesville, NC 28677 | 2008-07-29 |
| 1376688283 | Iredell Mem Hospital Cap Program | General Acute Care Hospital | 557 Brookdale Drive, Statesville, NC 28677 | 2007-02-20 |
| 1659454429 | Carl Dunkin | Physical Therapist | 557 Brookdale Drive, Statesville, NC 28677 | 2006-10-23 |
| 1083684518 | Imh Professional Path | General Acute Care Hospital | 557 Brookdale Drive, Statesville, NC 28677 | 2006-01-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306472311 | Crystal Medley Hopkins | Nurse Practitioner | 105 Summer Breeze Court, Statesville, NC 28677 | 2020-03-21 |
| 1922634484 | Tracey Holton | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Easterseals Ucp, 913 Carolina Ave N, Statesville, NC 28677 | 2020-03-17 |
| 1962069286 | Leap Child & Family Services LLC | Developmental Therapist | 119 North Tradd Street, Statesville, NC 28677 | 2019-05-22 |
| 1831604891 | Ingles Markets Inc | Pharmacy | 722 Sullivan Rd, Statesville, NC 28677 | 2017-12-12 |
| 1235663162 | Sandra Lorraine Scalese | Physical Therapy Assistant | 520 Valley Street, Brian Center Health and Rehabilitation, Statesville, NC 28677 | 2017-04-18 |
| 1437698891 | Sherry Blevins Hager | Pharmacist | 722 Sullivan Road, Statesville, NC 28677 | 2017-02-17 |
| 1063828507 | Susan Marie S Sheffield | Dentist | 518 Brookdale Drive, Statesville, NC 28677 | 2014-07-04 |
| 1659782449 | Easter Seals Ucp | Community/Behavioral Health | 913 Carolina Ave, Statesville, NC 28677 | 2014-05-14 |
| 1306268016 | Randall Scott Perry | Dentist | 1132 Davie Avenue, Statesville, NC 28677 | 2014-01-15 |
| 1215215876 | Silhouette Enterprises | Prosthetic/Orthotic Supplier | 909 Carolina Ave, Statesville, NC 28677 | 2011-08-01 |
| Find all providers in zip 28677 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336481639 | Wendy H Phillips | Skilled Nursing Facility | 2001 Van Haven Drive, Statesville, NC 28625-6208 | 2013-03-25 |
| 1427034099 | Autumn Corporation | Skilled Nursing Facility | 2001 Van Haven Dr, Statesville, NC 28625-4342 | 2005-12-15 |
| 1730722240 | Autumn Care of Statesville, LLC | Skilled Nursing Facility | 2001 Van Haven Dr, Statesville, NC 28625-4342 | 2019-10-28 |
| 1851825996 | Ssc Brian Center Health and Rehabilitation | Skilled Nursing Facility | 520 Valley St, Statesville, NC 28677-7935 | 2017-04-15 |
| 1891738977 | Statesville Hma Inc | Skilled Nursing Facility | 218 Old Mocksville Rd, Statesville, NC 28625-1930 | 2006-06-14 |
| 1760462196 | Iredell Memorial Hospital, Inc | Skilled Nursing Facility | 557 Brookdale Dr, Statesville, NC 28677-4107 | 2006-01-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164063756 | Cary Senior Housing I Opco, LLC | Skilled Nursing Facility | 221 Brightmore Dr, Cary, NC 27518-8145 | 2019-10-04 |
| 1629535455 | Liberty Healthcare Group, LLC | Skilled Nursing Facility | 621 Chestnut Ridge Pkwy, Blowing Rock, NC 28605-8962 | 2019-02-28 |
| 1871063214 | Vero Health X, LLC | Skilled Nursing Facility | 417 Cloverdale Rd, Sylva, NC 28779-0679 | 2018-11-28 |
| 1821573809 | Carolina Bay Healthcare Center of Wilmington, LLC | Skilled Nursing Facility | 740 Diamond Shoals Rd, Wilmington, NC 28403-4388 | 2018-09-26 |
| 1093228397 | Bellarose Nursing and Rehab Center, Inc. | Skilled Nursing Facility | 200 Bellarose Lake Way, Garner, NC 27529-7049 | 2017-11-08 |
| 1558872333 | Brunswick Health & Rehab Center, LLC | Skilled Nursing Facility | 9600 No 5 School Rd Nw, Ash, NC 28420-2122 | 2017-10-19 |
| 1538684212 | Eagle Acquisition Vi LLC | Skilled Nursing Facility | 901 S Halstead Blvd., Elizabeth City, NC 27909-6920 | 2017-08-03 |
| 1982130811 | Ashton Health and Rehabilitation, LLC | Skilled Nursing Facility | 5533 Burlington Rd, Mc Leansville, NC 27301-9622 | 2017-05-11 |
| 1831625037 | Supplemental Healthcare | Skilled Nursing Facility | 319 Vancouver Drive, Apartment 38g, Fayetteville, NC 28303 | 2017-05-08 |
| 1811422256 | Complete Care At Dartmouth LLC | Skilled Nursing Facility | 300 Province Road, Charlotte, NC 28207 | 2017-04-24 |
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| City | STATESVILLE |
| Zip Code | 28677 |
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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.