Healthcare Provider Details

I. General information

NPI: 1134765720
Provider Name (Legal Business Name): EC OPCO SHELBY LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 12/04/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 CHARLES ROAD
SHELBY NC
28152
US

IV. Provider business mailing address

1550 CHARLES ROAD
SHELBY NC
28152
US

V. Phone/Fax

Practice location:
  • Phone: 704-471-2828
  • Fax: 704-487-5084
Mailing address:
  • Phone: 704-471-2828
  • Fax: 704-487-5084

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 Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUELINE SIBLEY-NEWTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 704-471-2828