1. Home
  2. Directory
  3. North Carolina
  4. Clemmons
  5. Assisted Living Facility
  6. NPI Profile
Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

CLEMMONS VILLAGE I LLC
NPI 1013008234
Assisted Living Facility in Clemmons, NC

Active since September 27, 2006CLIA 34D2017300 · Waiver
6401 HOLDER RD, CLEMMONS, NC 27012(336) 766-2990(336) 766-2138 Get Directions Write a Review

NPPES record last updated: July 17, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Clemmons Village I Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLEMMONS VILLAGE I LLC (NPI 1013008234), doing business as Clemmons Village I, is a healthcare organization registered as an assisted living facility in Clemmons, North Carolina and active in the NPI registry since September 2006. The organization holds a CLIA Waiver certificate valid through December 7, 2026 and lists Eric Hadley, Coo, as its authorized official.

NPPES Registry Identity

NPI1013008234
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameCLEMMONS VILLAGE I LLC
Location Address6401 HOLDER RDClemmons, NC 27012-9207
Mailing Address6401 Holder RdClemmons, NC 27012-9207 · (336) 766-2990 · Fax (336) 766-2138
Phone(336) 766-2990
Fax(336) 766-2138
Organization SubpartNo
Authorized OfficialEric HadleyCoo · (843) 296-3985
Enumeration DateSeptember 27, 2006
Last NPPES UpdateJuly 17, 2026
NPPES CertifiedJuly 17, 2026
✔ NPI 1013008234 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in NC · HAL-034-090
Definition
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.
6401 HOLDER RD, Clemmons, NC 27012
Open in Google Maps ↗

Other Names 1

Doing Business AsClemmons Village I

Other Identifiers 1

Medicaid7805214NC

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2017300

Clemmons Village I · Clemmons, NC
Active · expires Dec 7, 2026
CLIA Number34D2017300
Laboratory TypeAssisted Living Facility
Certificate Effective DateDecember 8, 2024
Certificate Expiration DateDecember 7, 2026
Laboratory DirectorKathy Edens-Briggs
Laboratory Phone(336) 766-2990
Laboratory LocationClemmons Village I6401 Holder Road, Clemmons, NC 27012
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Clemmons Village I LLC's NPI number?

The NPI number for Clemmons Village I LLC is 1013008234. It was assigned to this organization in the NPPES registry on September 27, 2006. The provider is doing business as Clemmons Village I.

Where is Clemmons Village I LLC located?

Clemmons Village I LLC is located at 6401 Holder Rd, Clemmons, NC 27012. The listed phone number is (336) 766-2990.

What is Clemmons Village I LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Clemmons Village I LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2017300) is associated with this NPI, valid through December 7, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Clemmons Village I LLC was last updated on July 17, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 43 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.