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NPI Code Detail

MEDICARE: SOUTHERN LIVING FOR SENIORS OF NEW BERN NC LLC

MEDICARE: SOUTHERN LIVING FOR SENIORS OF NEW BERN NC 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
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1790274868
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN LIVING FOR SENIORS OF NEW BERN NC LLC
Provider Business Mailing Address
First Line : 3407 OAKS RD
Second Line :
City : NEW BERN
State : NC
Zip : 28560-2718
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3407 OAKS RD
Second Line :
City : NEW BERN
State : NC
Zip : 28560-2718
Country : US
Telephone Number : 850-253-5990
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : KENNETH MARK SIMONS
Credential :
Telephone Number : 850-259-5990
Provider Enumeration Date : 05/04/2018
Last Update Date : 05/04/2018

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Directions to “SOUTHERN LIVING FOR SENIORS OF NEW BERN NC LLC ” Practice Location

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