=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568595288
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LINVILLE HEIGHTS ADULT CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 07/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1095 PADDYS CREEK RD
-----------------------------------------------------
City | NEBO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28761-8606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-584-2360
-----------------------------------------------------
Fax | 828-584-8090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1095 PADDYS CREEK RD
-----------------------------------------------------
City | NEBO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28761-8606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-584-2360
-----------------------------------------------------
Fax | 828-584-8090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADM.
-----------------------------------------------------
Name | MRS. JEAN WHITE MCCARTHY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-584-2360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | FCL012-010
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------