Healthcare Provider Details

I. General information

NPI: 1821551797
Provider Name (Legal Business Name): CITADEL AT WINSTON SALEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W 1ST ST
WINSTON SALEM NC
27104-4220
US

IV. Provider business mailing address

1900 W 1ST ST
WINSTON SALEM NC
27104-4220
US

V. Phone/Fax

Practice location:
  • Phone: 336-724-2821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: BATYA GORELICK
Title or Position: VP OF ADMINISTRATIVE SERVICES
Credential:
Phone: 336-724-2821