Healthcare Provider Details

I. General information

NPI: 1922297597
Provider Name (Legal Business Name): LOUAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 OAKS RD
NEW BERN NC
28560-2718
US

IV. Provider business mailing address

PO BOX 1487
KERNERSVILLE NC
27285-1487
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-1143
  • Fax: 252-633-0422
Mailing address:
  • Phone: 336-595-1075
  • Fax: 336-595-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AL STEPHEN PIERCE
Title or Position: MEMBER
Credential:
Phone: 336-595-1075