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KINGS MOUNTAIN MEMORY CARE CENTER
NPI 1033343157
Custodial Care Facility - Adult Care Home in Kings Mountain, NC

Active since May 04, 2009CLIA 34D2029118 · Waiver
115 FERGUSON DR, KINGS MOUNTAIN, NC 28086(704) 739-5929(704) 739-1103 Get Directions Write a Review

NPPES record last updated: September 4, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 4, 2024, Dec 6, 2023, Nov 17, 2023 (3 updates tracked since 2023).

About Kings Mountain Memory Care Center NPPES

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

KINGS MOUNTAIN MEMORY CARE CENTER (NPI 1033343157) is a healthcare organization registered as an adult care home in Kings Mountain, North Carolina and active in the NPI registry since May 2009. The organization holds a CLIA Waiver certificate valid through August 30, 2027 and lists Patricia Odegua Adelekun, President, as its authorized official.

NPPES Registry Identity

NPI1033343157
Entity TypeOrganization
Primary Taxonomy311ZA0620X
Legal Business NameKINGS MOUNTAIN MEMORY CARE CENTER
Location Address115 FERGUSON DRKings Mountain, NC 28086-9727
Mailing AddressPo Box 1873Kings Mountain, NC 28086-1873
Phone(704) 739-5929
Fax(704) 739-1103
Organization SubpartNo
Authorized OfficialPatricia Odegua AdelekunPresident · (704) 718-2327
Enumeration DateMay 4, 2009
Last NPPES UpdateSeptember 4, 20243 updates tracked since enumeration
NPPES CertifiedSeptember 4, 2024
✔ NPI 1033343157 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCustodial Care Facility · Adult Care HomeNursing & Custodial Care Facilities
Taxonomy Code311ZA0620X
Definition
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
115 FERGUSON DR, Kings Mountain, NC 28086
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Other Names 1

Other NameKings Mountain Memory Care Center

Other Identifiers 1

Medicaid7801288NC

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 34D2029118

Kings Mountain Memory Care Center LLC · Kings Mountain, NC
Active · expires Aug 30, 2027
CLIA Number34D2029118
Laboratory TypeAssisted Living Facility
Certificate Effective DateAugust 31, 2025
Certificate Expiration DateAugust 30, 2027
Laboratory DirectorPatricia Adelekun
Laboratory Phone(704) 739-5929
Laboratory LocationKings Mountain Memory Care Center LLC115 Ferguson Drive, Kings Mountain, NC 28086
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KINGS MOUNTAIN CARE CENTER INC.
Assisted Living Facility
115 FERGUSON DR
KINGS MOUNTAIN, NC 28086
Cleveland County (704) 739-5929

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 Kings Mountain Memory Care Center's NPI number?

The NPI number for Kings Mountain Memory Care Center is 1033343157. It was assigned to this organization in the NPPES registry on May 4, 2009.

Where is Kings Mountain Memory Care Center located?

Kings Mountain Memory Care Center is located at 115 Ferguson Dr, Kings Mountain, NC 28086. The listed phone number is (704) 739-5929.

What is Kings Mountain Memory Care Center's specialty?

The primary specialty registered for this NPI is Custodial Care Facility, specializing in Adult Care Home, with taxonomy code 311ZA0620X.

Does Kings Mountain Memory Care Center hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2029118) is associated with this NPI, valid through August 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Kings Mountain Memory Care Center was last updated on September 4, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months 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.