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General NPI Number Information
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NPI Number | 1275139966
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Entity Type | Organization
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Legal Business Name | ASHEVILLE GERIATRIC LLC
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 95 RICHMOND HILL RD
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City | ASHEVILLE
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State | NC
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Zip | 28806-3918
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Country | US
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Telephone | 704-989-5736
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Fax |
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Provider Business Mailing Address
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Address Line | 95 RICHMOND HILL RD
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City | ASHEVILLE
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State | NC
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Zip | 28806-3918
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Country | US
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Telephone | 704-989-5736
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Fax |
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Authorized Official
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Title or Position | MANAGING AGENT
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Name | DR. PHANI MOHAN VUPADHYAYULA
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Credential | MD, MBA
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Telephone | 704-989-5736
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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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