Healthcare Provider Details

I. General information

NPI: 1801065933
Provider Name (Legal Business Name): EC SOUTHERN PINES OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BRUCEWOOD RD
SOUTHERN PINES NC
28387-5159
US

IV. Provider business mailing address

9510 ORMSBY STATION RD
LOUISVILLE KY
40223-4081
US

V. Phone/Fax

Practice location:
  • Phone: 910-692-4928
  • Fax: 910-692-0899
Mailing address:
  • Phone: 502-753-6000
  • Fax: 502-753-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHAL-063-020
License Number StateNC

VIII. Authorized Official

Name: MR. W. PATRICK MULLOY II
Title or Position: PRESIDENT
Credential:
Phone: 502-753-6001