Basic Information
| Provider Information | |||||||||
| NPI: | 1306973433 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KAPSON DANBY, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DBA THE HOMESTEAD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10706 SIKES PL STE 150 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282778140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042461620 | ||||||||
| FaxNumber: | 7042461621 | ||||||||
| Practice Location | |||||||||
| Address1: | 3150 BURKE MILL RD | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271036431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366590708 | ||||||||
| FaxNumber: | 3366598506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | O. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7042461620 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | HAL-034-032 | NC | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 7805787 | 05 | NC | MEDICAID |