Healthcare Provider Details

I. General information

NPI: 1801366034
Provider Name (Legal Business Name): SISTERS LIVING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 ZIMMERMAN RD
BLANCH NC
27212-9031
US

IV. Provider business mailing address

PO BOX 58424
RALEIGH NC
27658-8424
US

V. Phone/Fax

Practice location:
  • Phone: 336-514-5868
  • Fax:
Mailing address:
  • Phone: 336-514-5868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: AMANDA SCOTT
Title or Position: PRESIDENT
Credential:
Phone: 336-514-5868