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General NPI Number Information
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NPI Number | 1134251572
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Entity Type | Organization
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Legal Business Name | MOUNTAIN MANOR ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 270 LOVE FOX ROAD
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City | BURNSVILLE
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State | NC
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Zip | 28714-9109
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Country | US
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Telephone | 828-682-3417
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9790
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City | ASHEVILLE
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State | NC
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Zip | 28815-0790
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Country | US
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Telephone | 336-416-7149
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Fax | 336-751-5430
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD B DODSON
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Credential |
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Telephone | 336-416-7149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | HAL 100-002
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License Number State | NC
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