Healthcare Provider Details

I. General information

NPI: 1376813600
Provider Name (Legal Business Name): EMANUEL HOUSE ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 ALAMANCE CT
GREENSBORO NC
27406-3806
US

IV. Provider business mailing address

2008 INDIA HOOK RD
ROCK HILL SC
29732-1220
US

V. Phone/Fax

Practice location:
  • Phone: 980-275-0698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL-041-076
License Number StateNC

VIII. Authorized Official

Name: NIKITA BLAKENEY
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 980-275-0698