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General NPI Number Information
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NPI Number | 1033343157
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Entity Type | Organization
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Legal Business Name | KINGS MOUNTAIN MEMORY CARE CENTER
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 115 FERGUSON DR
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-9727
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Country | US
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Telephone | 704-739-5929
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Fax | 704-739-1103
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Provider Business Mailing Address
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Address Line | PO BOX 1873
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-1873
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICIA ODEGUA ADELEKUN
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Credential | RN, MBA
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Telephone | 704-718-2327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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