Healthcare Provider Details

I. General information

NPI: 1932481249
Provider Name (Legal Business Name): BYPETERSON PROPERTIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 CLINARD RD
CLEMMONS NC
27012-8487
US

IV. Provider business mailing address

4430 CLINARD RD
CLEMMONS NC
27012-8487
US

V. Phone/Fax

Practice location:
  • Phone: 336-766-5000
  • Fax: 336-766-5020
Mailing address:
  • Phone: 336-766-5000
  • Fax: 336-766-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number StateNC

VIII. Authorized Official

Name: BRENDA K. PETERSON
Title or Position: MEMBER MANAGER
Credential:
Phone: 704-502-3210