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MALLARD RIDGE LLC
NPI 1861523896
Assisted Living Facility in Kernersville, NC

Active since March 09, 2007
851 OLD WINSTON RD, KERNERSVILLE, NC 27284(336) 993-7555 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mallard Ridge Llc NPPES

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

MALLARD RIDGE LLC (NPI 1861523896) is a healthcare organization registered as an assisted living facility in Kernersville, North Carolina and active in the NPI registry since March 2007. The organization lists Tracy Hennessee, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1861523896
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameMALLARD RIDGE LLC
Location Address851 OLD WINSTON RDKernersville, NC 27284-8780
Mailing Address851 Old Winston RdKernersville, NC 27284-8780 · (336) 775-2205
Phone(336) 993-7555
Organization SubpartNo
Authorized OfficialTracy HennesseeExecutive Director · (336) 775-2205
Enumeration DateMarch 9, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1861523896 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 029 007
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.
851 OLD WINSTON RD, Kernersville, NC 27284
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Other Identifiers 1

Medicaid7805429NC

Other Providers at the Same Location NPPES 7

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

PREFERRED PAIN MANAGEMENT, P.A.
Pain Medicine (Pain Medicine)
851 OLD WINSTON RD, SUITE 105
KERNERSVILLE, NC 27284
Forsyth County (336) 760-0706
MR. SCOTT A. ADAMSONS B.A., BC-HIS
Hearing Instrument Specialist
851 OLD WINSTON RD, SUITE 108
KERNERSVILLE, NC 27284
Forsyth County (336) 497-5436
DANA M. TRUMAN-SCHRAM MA, LPA
Psychologist
851 OLD WINSTON RD, SUITE 107
KERNERSVILLE, NC 27284
Forsyth County (336) 480-1955
DR. DAVID DILLON PARKS D.C.
Chiropractor
851 OLD WINSTON RD, SUITE 105
KERNERSVILLE, NC 27284
Forsyth County (336) 993-9690
DR. JESSE ARON GRIMM DDS
Dentist (General Practice)
851 OLD WINSTON RD, SUITE 101
KERNERSVILLE, NC 27284
Forsyth County (336) 996-7770
KATHERINE SUSANNE ROLLINS PSYD
Psychologist
851 OLD WINSTON RD, SUITE 107
KERNERSVILLE, NC 27284
Forsyth County (336) 992-2171
DR. MEGAN KEY GABALDA PH.D.
Psychologist (Clinical)
851 OLD WINSTON RD, SUITE 107
KERNERSVILLE, NC 27284
Forsyth County (336) 996-9840

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 Mallard Ridge LLC's NPI number?

The NPI number for Mallard Ridge LLC is 1861523896. It was assigned to this organization in the NPPES registry on March 9, 2007.

Where is Mallard Ridge LLC located?

Mallard Ridge LLC is located at 851 Old Winston Rd, Kernersville, NC 27284. The listed phone number is (336) 993-7555.

What is Mallard Ridge LLC's specialty?

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

When was this NPI record last updated?

The NPPES record for Mallard Ridge 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.