INDEPENDENT LIVING GROUP HOME, LLC (NPI# 1093991234) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093991234 |
| Entity Type | Organization |
| Organization Name | INDEPENDENT LIVING GROUP HOME, LLC |
| Practice Address |
924 Cloister Dr Winston Salem NC 27127 |
| Mailing Address |
7748 N Point Blvd Winston Salem NC 27106-3310 |
| Practice Telephone | 3367674540 |
| Practice Fax Number | 3362839288 |
| Mailing Telephone | 3367674540 |
| Mailing Fax Number | 3364990651 |
| Enumeration Date | 2008-01-17 |
| Last Update Date | 2019-11-18 |
| Authorized Official Name | SHANITA LOVELACE (DIRECTOR/ OWNER) |
| Authorized Official Telephone | 3367674540 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
Nursing & Custodial Care Facilities | ||
| N | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 034-224 | NC | Residential Treatment Facilities |
| N | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities | ||
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2415 Old Salisbury Rd, Winston Salem, NC 271275823 | 3367882319 | 3362839288 |
| 1712 Thompson Dr, Winston Salem, NC 271275814 | 3367885781 | 3362839288 |
| 1316 Calvert Dr, Winston Salem, NC 271071302 | 3368423384 | 3362839288 |
| 355 Ransom Rd, Winston Salem, NC 271063835 | 3368935495 | 3362839288 |
| 7748 N Point Blvd, Winston Salem, NC 271063310 | 3367674540 | 3362839288 |
| 4401 Cherry St Ste 50, Winston Salem, NC 271052500 | (336) 767-4540 | 3364990651 |
| Street Address |
924 CLOISTER DR |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27127 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821695164 | North Davidson Dialysis Center of Wake Forest University | Clinic/Center | 295 Millers Creek Drive, Winston Salem, NC 27127 | 2020-10-08 |
| 1326654963 | Procare Home Health, LLC | Home Health | 12133 Nc-150 Suite C, Winston-salem, NC 27127 | 2020-09-18 |
| 1952809576 | Lamboy and Rubio Dds Pa | Dentist | 2563 Peters Creek Pkwy, Winston Salem, NC 27127 | 2018-01-29 |
| 1427403815 | Ramona Rorie Griffin Noble | Counselor | 1348 Westgate Center Drive Suite 202, Winston Salem, NC 27127 | 2016-05-04 |
| 1205295680 | Kia Johnson | Dentist | 2101 Peters Creek Pkwy Ste 16-19, Winston Salem, NC 27127 | 2016-02-15 |
| 1487030060 | Llibott Consultorios Medicos- Ws,pllc | Clinic/Center | 1145 Silas Creek Pkwy, Winston Salem, NC 27127 | 2015-08-05 |
| 1740688266 | Bonnie M. Clifton | Specialist/Technologist | 800 Salisbury Ridge Rd, Winston-salem, NC 27127 | 2014-12-16 |
| 1740606706 | Yen T Nguyen Dmd Pllc | Dentist | 2375 Brewer Road, Winston-salem, NC 27127 | 2014-03-13 |
| 1316254451 | Marquis D. Bailey | Specialist | 200 Alexander Preston Ln, Winston - Salem, NC 27127 | 2010-09-10 |
| 1093870909 | Wal-mart Store East, Lp | Technician/Technologist | 1330 W. Clemmnonsville Rd., Winston Salem, NC 27127 | 2006-12-22 |
| Find all providers in zip 27127 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407489529 | It Takes A Village Residential Care LLC | Community/Behavioral Health | 5008 Butterfield Dr, Winston Salem, NC 27105-3344 | 2020-02-17 |
| 1265070890 | Monarch | Community/Behavioral Health | 2680 Grosvenor Pl Apt 1, Winston Salem, NC 27106-5244 | 2019-12-13 |
| 1457810491 | Marilyn Marie Holder | Community/Behavioral Health | 3215 Linda Cir, Winston Salem, NC 27106-3023 | 2019-03-19 |
| 1306362017 | The Gracen Foundation | Community/Behavioral Health | 1140 Old Hollow Rd, Winston Salem, NC 27105-8709 | 2017-08-15 |
| 1720529357 | Rising Hope Clinical Assistance, LLC | Community/Behavioral Health | 510 Northgate Park Dr, Winston Salem, NC 27106 | 2017-03-15 |
| 1962940601 | Kenya Thornton | Community/Behavioral Health | 1225 East 5th, Suite 100, Winston Salem, NC 27101 | 2017-02-02 |
| 1881076446 | Monarch | Community/Behavioral Health | 967 Salisbury Ridge Rd, Winston Salem, NC 27127-3709 | 2015-06-19 |
| 1487032249 | Monarch | Community/Behavioral Health | 2844 Reynolda Rd, Winston Salem, NC 27106-3102 | 2015-05-13 |
| 1467839696 | Aria Health LLC | Community/Behavioral Health | 5312 Summit Heights Dr, Winston Salem, NC 27104-4479 | 2015-04-27 |
| 1194128629 | Valerie Benton Center | Community/Behavioral Health | 8 W 3rd St Ste 220, Winston Salem, NC 27101-3977 | 2014-09-29 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27127 |
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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.