Healthcare Provider Details

I. General information

NPI: 1003160441
Provider Name (Legal Business Name): BURLINGTON AL HOLDINGS I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2766 GRAND OAKS BOULEVARD
BURLINGTON NC
27215-0000
US

IV. Provider business mailing address

PO BOX 2568
HICKORY NC
28603-2568
US

V. Phone/Fax

Practice location:
  • Phone: 336-261-0021
  • Fax: 336-261-0153
Mailing address:
  • Phone: 828-261-7304
  • Fax: 828-322-4538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberHAL-001-148
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: CHARLES E TREFZGER
Title or Position: MANAGER
Credential:
Phone: 828-322-5535