ENTERPRISE HEALTHCARE OF STATESVILLE
Adult Care Home
Statesville, North Carolina
Provider NPI: 1417071457
Organization Information:Organization Name: ENTERPRISE HEALTHCARE OF STATESVILLE
Practice Location:
1942 VAN HAVEN DR STATESVILLE, NC 28625 US
Tel: 704-878-0046 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
1942 VAN HAVEN DR STATESVILLE, NC 28625 US
Tel: 704-878-0046 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 311ZA0620X | Nursing & Custodial Care Facilities Custodial Care Facility Adult Care Home | NC | HAL-049-015 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
7803811 | NC | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin