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PIGEON VALLEY REST HOME LLC
NPI 1528051935
Custodial Care Facility - Adult Care Home in Canton, NC

Active since August 31, 2005CLIA 34D2193740 · Waiver
55 LAKE DR, CANTON, NC 28716(828) 648-2044(828) 648-2065 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Pigeon Valley Rest Home Llc NPPES

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

PIGEON VALLEY REST HOME LLC (NPI 1528051935) is a healthcare organization registered as an adult care home in Canton, North Carolina and active in the NPI registry since August 2005. The organization holds a CLIA Waiver certificate valid through September 23, 2026 and lists Bobby N Leatherwood, Administrator, as its authorized official.

NPPES Registry Identity

NPI1528051935
Entity TypeOrganization
Primary Taxonomy311ZA0620X
Legal Business NamePIGEON VALLEY REST HOME LLC
Location Address55 LAKE DRCanton, NC 28716-9312
Mailing Address100 Silver Bluff DrCanton, NC 28716-6350 · (828) 648-2044 · Fax (828) 648-2065
Phone(828) 648-2044
Fax(828) 648-2065
Organization SubpartNo
Authorized OfficialBobby N LeatherwoodAdministrator · (828) 648-2044
Enumeration DateAugust 31, 2005
Last NPPES UpdateAugust 22, 2020
✔ NPI 1528051935 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
License✔ Licensed in NC · HAL044012
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.
55 LAKE DR, Canton, NC 28716
Open in Google Maps ↗

Other Identifiers 1

Medicaid7801751NC

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 34D2193740

Pigeon Valley Rest Home · Canton, NC
Active · expires Sep 23, 2026
CLIA Number34D2193740
Laboratory TypeAssisted Living Facility
Certificate Effective DateSeptember 24, 2024
Certificate Expiration DateSeptember 23, 2026
Laboratory DirectorLisa L. Leatherwood
Laboratory Phone(828) 648-2044
Laboratory LocationPigeon Valley Rest Home55 Lake Drive, Canton, NC 28716
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 Pigeon Valley Rest Home LLC's NPI number?

The NPI number for Pigeon Valley Rest Home LLC is 1528051935. It was assigned to this organization in the NPPES registry on August 31, 2005.

Where is Pigeon Valley Rest Home LLC located?

Pigeon Valley Rest Home LLC is located at 55 Lake Dr, Canton, NC 28716. The listed phone number is (828) 648-2044.

What is Pigeon Valley Rest Home LLC's specialty?

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

Does Pigeon Valley Rest Home LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2193740) is associated with this NPI, valid through September 23, 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 Pigeon Valley Rest Home LLC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.