LEGACY HEIGHTS SENIOR LIVING COMMUNITY
NPI 1194877001
Assisted Living Facility in Charlotte, NC

Q: What is Five Star Quality Care - Obx Operator, LLC's specialty?

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

Active since January 18, 2007CLIA 34D1089262 · Waiver

11230 BALLANTYNE TRACE COURT, CHARLOTTE, NC 28277(704) 544-7220(704) 544-7221 Get Directions Write a Review

NPPES record last updated: March 28, 2019. Verified against the NPPES registry weekly; last sync: August 30, 2026.

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About Legacy Heights Senior Living Community NPPES

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

LEGACY HEIGHTS SENIOR LIVING COMMUNITY (NPI 1194877001) is a healthcare organization registered as an assisted living facility in Charlotte, North Carolina and active in the NPI registry since January 2007. The organization holds a CLIA Waiver certificate valid through September 14, 2026 and lists Katherine E Potter, President & Chief Executive Officer, as its authorized official.

NPPES Registry Identity

NPI1194877001

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameFIVE STAR QUALITY CARE - OBX OPERATOR, LLC

Location Address11230 BALLANTYNE TRACE COURTCharlotte, NC 28277

Mailing Address400 Centre StreetNewton, MA 02458 · (617) 796-8160

Phone(704) 544-7220

Fax(704) 544-7221

Organization SubpartYes

Authorized OfficialKatherine E PotterPresident & Chief Executive Officer · (617) 796-8387

Enumeration DateJanuary 18, 2007

Last NPPES UpdateMarch 28, 2019

✔ NPI 1194877001 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-060-086

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.

11230 BALLANTYNE TRACE COURT, Charlotte, NC 28277

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Other Names 1

Doing Business AsLegacy Heights Senior Living Community

Other Identifiers 1

Medicaid7806166NC

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 34D1089262

Legacy Heights · Charlotte, NC

Active · expires Sep 14, 2026

CLIA Number34D1089262

Laboratory TypeAssisted Living Facility

Certificate Effective DateSeptember 15, 2024

Certificate Expiration DateSeptember 14, 2026

Laboratory DirectorChristopher Pauline

Laboratory Phone(704) 544-7220

Laboratory LocationLegacy Heights11230 Ballantyne Trace Court, Charlotte, NC 28277

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 Five Star Quality Care - Obx Operator, LLC's NPI number?

The NPI number for Five Star Quality Care - Obx Operator, LLC is 1194877001. It was assigned to this organization in the NPPES registry on January 18, 2007. The provider is doing business as Legacy Heights Senior Living Community.

Where is Five Star Quality Care - Obx Operator, LLC located?

Five Star Quality Care - Obx Operator, LLC is located at 11230 Ballantyne Trace Court, Charlotte, NC 28277. The listed phone number is (704) 544-7220.

What is Five Star Quality Care - Obx Operator, LLC's specialty?

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

Does Five Star Quality Care - Obx Operator, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D1089262) is associated with this NPI, valid through September 14, 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 Five Star Quality Care - Obx Operator, LLC was last updated on March 28, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years 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.