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General NPI Number Information
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NPI Number | 1295077105
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Entity Type | Organization
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Legal Business Name | SENIOR CARE OF GOLDSBORO, INC
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 14736 POPLAR ST
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City | GOLDSBORO
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State | MD
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Zip | 21636-1307
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Country | US
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Telephone | 410-924-7360
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Fax | 410-482-9307
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Provider Business Mailing Address
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Address Line | 14736 POPLAR ST
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City | GOLDSBORO
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State | MD
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Zip | 21636-1307
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Country | US
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Telephone | 410-924-7360
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Fax | 410-482-9307
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Authorized Official
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Title or Position | OWNER, MANAGER
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Name | MRS. TAMMY MERSON
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Credential | RN
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Telephone | 410-924-7360
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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 | 05AL0046-A
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License Number State | MD
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