Healthcare Provider Details

I. General information

NPI: 1962479840
Provider Name (Legal Business Name): TRC OF SALISBURY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 S SALISBURY AVE
SPENCER NC
28159-1921
US

IV. Provider business mailing address

PO BOX 5
SPENCER NC
28159-0005
US

V. Phone/Fax

Practice location:
  • Phone: 704-633-3892
  • Fax: 704-637-2784
Mailing address:
  • Phone: 704-633-3892
  • Fax: 704-637-2784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHAL-080-009
License Number StateNC

VIII. Authorized Official

Name: MR. NICK ELLEDGE
Title or Position: VICE PRESIDENT
Credential:
Phone: 336-679-8852