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General NPI Number Information
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NPI Number | 1134765720
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Entity Type | Organization
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Legal Business Name | EC OPCO SHELBY LP
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 1550 CHARLES ROAD
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City | SHELBY
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State | NC
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Zip | 28152
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Country | US
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Telephone | 704-471-2828
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Fax | 704-487-5084
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Provider Business Mailing Address
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Address Line | 1550 CHARLES ROAD
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City | SHELBY
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State | NC
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Zip | 28152
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Country | US
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Telephone | 704-471-2828
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Fax | 704-487-5084
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JACQUELINE SIBLEY-NEWTON
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Credential |
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Telephone | 704-471-2828
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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 |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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