Healthcare Provider Details

I. General information

NPI: 1114126224
Provider Name (Legal Business Name): ALBEMARLE SENIOR LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 ROSEDALE DR
ELIZABETH CITY NC
27909-9810
US

IV. Provider business mailing address

520 MULBERRY ST
SHALLOTTE NC
28470-4586
US

V. Phone/Fax

Practice location:
  • Phone: 252-331-2149
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID BURNS GOLDSTON III
Title or Position: PRESIDENT
Credential:
Phone: 910-754-6621