MEDICARE: CHATHAM RIDGE ASSISTED LIVING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	HAL019021	NC

General Provider Information

NPI Number	:	1467839217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHATHAM RIDGE ASSISTED LIVING, LLC

Provider Business Mailing Address
First Line	:	853 OLD WINSTON RD
Second Line	:	SUITE 118
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-7143
Country	:	US
Telephone Number	:	336-993-6111
Fax Number	:	336-993-7555

Provider Business Practice Location Address
First Line	:	114 POLKS VILLAGE LANE
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27515
Country	:	US
Telephone Number	:	919-918-7872
Fax Number	:	919-918-7876

Authorized Official
Title or Position	:	VP FINANCE
Name	:	CYNTHIA ANN NEAGLE
Credential	:
Telephone Number	:	336-993-7555

Provider Enumeration Date	:	04/30/2015
Last Update Date	:	10/12/2020

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