| NPI | 1417951492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIM JACKSON Administrator 336-292-8187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: NC NH0190) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: NC NH0190) |
| 313M00000X Nursing Facility/Intermediate Care Facility (Licence: NC NH0190) | |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2014-11-06 |