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General NPI Number Information
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NPI Number | 1275335804
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Entity Type | Organization
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Legal Business Name | GATESVILLE AL-MC LLC
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 11 COMMERCE DR
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City | GATESVILLE
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State | NC
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Zip | 27938-9551
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Country | US
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Telephone | 252-584-3831
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Fax |
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Provider Business Mailing Address
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Address Line | 5430 WADE PARK BLVD STE 310
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City | RALEIGH
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State | NC
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Zip | 27607-4191
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Country | US
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Telephone | 919-621-2093
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JENNILEE M RICHARDSON
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Credential |
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Telephone | 919-621-2093
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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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