Healthcare Provider Details

I. General information

NPI: 1083754410
Provider Name (Legal Business Name): MEADOWWOODS ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HOMEWOOD AVE
BURLINGTON NC
27217-2839
US

IV. Provider business mailing address

PO BOX 1996
BURLINGTON NC
27216-1996
US

V. Phone/Fax

Practice location:
  • Phone: 336-228-8838
  • Fax: 336-228-8838
Mailing address:
  • Phone: 336-226-8838
  • Fax: 336-226-8838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberFCL-001-092
License Number StateNC

VIII. Authorized Official

Name: MS. MITTIE B FULLER
Title or Position: ADMINISTRATOR-OWNER
Credential:
Phone: 336-684-2282