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General NPI Number Information
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NPI Number | 1083754410
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Entity Type | Organization
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Legal Business Name | MEADOWWOODS ASSISTED LIVING
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 HOMEWOOD AVE
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City | BURLINGTON
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State | NC
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Zip | 27217-2839
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Country | US
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Telephone | 336-228-8838
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Fax | 336-228-8838
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Provider Business Mailing Address
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Address Line | PO BOX 1996
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City | BURLINGTON
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State | NC
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Zip | 27216-1996
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Country | US
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Telephone | 336-226-8838
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Fax | 336-226-8838
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Authorized Official
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Title or Position | ADMINISTRATOR-OWNER
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Name | MS. MITTIE B FULLER
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Credential |
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Telephone | 336-684-2282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | FCL-001-092
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License Number State | NC
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