Healthcare Provider Details

I. General information

NPI: 1043368889
Provider Name (Legal Business Name): NCAL-ACQUISITION 1, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 HARDIN DR
SHELBY NC
28150-3500
US

IV. Provider business mailing address

1105 BROOKSTOWN AVE
WINSTON SALEM NC
27101-2524
US

V. Phone/Fax

Practice location:
  • Phone: 704-480-9800
  • Fax: 704-480-9803
Mailing address:
  • Phone: 336-724-1000
  • Fax: 336-724-9955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberHAL-023-012
License Number StateNC

VIII. Authorized Official

Name: WILLIAM BENTON
Title or Position: CEO
Credential:
Phone: 336-724-1000