SOUTHPARK SENIOR LIVING LLC
Alzheimer Center
Charlotte, North Carolina
Provider NPI: 1982724100
Organization Information:Organization Name: SOUTHPARK SENIOR LIVING LLC
Practice Location:
2101 RUNNYMEDE LN CHARLOTTE, NC 28209 US
Tel: 704-525-5508 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:
2101 RUNNYMEDE LN CHARLOTTE, NC 28209 US
Tel: 704-525-5508 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 311500000X | Nursing & Custodial Care Facilities Alzheimer Center (Dementia Center) | NC | HAL060076 |
Y | 310400000X | Nursing & Custodial Care Facilities Assisted Living Facility | NC | HAL060076 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
7805207 | NC | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin