Healthcare Provider Details

I. General information

NPI: 1316789274
Provider Name (Legal Business Name): SPRINGDAILE ASSISTED LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 HOLDER RD
DURHAM NC
27703-9654
US

IV. Provider business mailing address

4315 HOLDER RD
DURHAM NC
27703-9654
US

V. Phone/Fax

Practice location:
  • Phone: 919-908-0418
  • Fax:
Mailing address:
  • Phone: 919-908-0418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: KUNTAL MERCHANT
Title or Position: MANAGER
Credential:
Phone: 919-525-0874