CLEMMONS VILLAGE I, LLC
NPI 1013008234
Assisted Living Facility in Clemmons, NC
NPI Status: Active since September 27, 2006
Contact Information
6401 HOLDER RD
CLEMMONS, NC
ZIP 27012
Phone: (336) 766-2990
Fax: (336) 766-2138
Some details in this NPI profile have been updated in the NPI registry within the last 30 days.
- Organization
- Assisted Living Facility
- CLIA Number: 34D2017300
- CLIA Cert. Type: Assisted Living Facility
- CLIA Exp. Date: 12-07-2026
About CLEMMONS VILLAGE I, LLC
This page provides the complete NPI Profile along with additional information for Clemmons Village I, Llc, a provider established in Clemmons, North Carolina operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1013008234 assigned on September 2006. The practitioner's primary taxonomy code is 310400000X with license number HAL-034-090 (NC). The provider is registered as an organization and their NPI record was last updated June 2026. The provider's
- NPI
- 1013008234
- Provider Legal Name
- CLEMMONS VILLAGE I, LLC
- Other Organization Name
- Other Name Type
- (6)
- Entity Type
- Organization
- Location Address
- 6401 HOLDER RD CLEMMONS, NC 27012
- Location Phone
- (336) 766-2990
- Location Fax
- (336) 766-2138
- Mailing Address
- 6401 HOLDER RD CLEMMONS, NC 27012
- Mailing Phone
- (336) 766-2990
- Mailing Fax
- (336) 766-2138
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 09-27-2006
- Last Update Date
- 06-25-2026
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Assisted Living Facility
- Taxonomy Code
- 310400000X
- Type
- Nursing & Custodial Care Facilities
- License No.
- HAL-034-090
- License State
- NC
- Taxonomy Description
- A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 7805214 | MEDICAID (05) | NC |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 34D2017300
- Facility Type
- Assisted Living Facility
- Certificate Effective Date
- December 08, 2024
- Certificate Expiration Date
- December 07, 2026
- Laboratory Director
- KATHY EDENS-BRIGGS
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Clemmons Village I, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1013008234, we treat the final digit (4) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 46. The final step is to find the difference between that total and the next multiple of ten (50 - 46 = 4).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 46 is 50. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1013008234, enumerated as an "organization" on September 27, 2006.
The provider is located at 6401 HOLDER RD CLEMMONS, NC 27012 and the phone number is (336) 766-2990.
Assisted Living Facility with taxonomy code 310400000X.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
