Healthcare Provider Details

I. General information

NPI: 1750952438
Provider Name (Legal Business Name): EC OPCO SOUTHERN PINES, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 07/05/2021
Certification Date: 07/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BRUCEWOOD RD
SOUTHERN PINES NC
28387-5159
US

IV. Provider business mailing address

5885 MEADOWS RD STE 500
LAKE OSWEGO OR
97035-8646
US

V. Phone/Fax

Practice location:
  • Phone: 910-692-4928
  • Fax: 910-692-0899
Mailing address:
  • Phone: 971-213-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: AMY W. FLEMING
Title or Position: CONTROLLER OF MANAGEMENT COMPANY
Credential:
Phone: 971-227-3922