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General NPI Number Information
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NPI Number | 1548521115
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Entity Type | Organization
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Legal Business Name | MITCHELL HOUSE ONE, LLC
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Dates
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Enumeration Date | 05/31/2012
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 13681 HWY 226 SOUTH
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City | SPRUCE PINE
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State | NC
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Zip | 28777
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Country | US
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Telephone | 828-766-7771
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Fax | 828-766-5862
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Provider Business Mailing Address
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Address Line | 962 WAYNE AVE SUITE 900
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City | SILVER SPRING
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State | MD
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Zip | 20910-4433
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Country | US
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Telephone | 240-841-2919
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Fax | 240-841-2630
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Authorized Official
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Title or Position | MANAGER
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Name | CHARLES E TREFZGER
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Credential |
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Telephone | 828-322-5535
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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-061-011
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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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 | 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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