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General NPI Number Information
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NPI Number | 1598785305
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Entity Type | Organization
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Legal Business Name | PIEDMONT VILLAGE AT YADKINVILLE, INC.
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 305 HARRISON AVE
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City | YADKINVILLE
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State | NC
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Zip | 27055-8247
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Country | US
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Telephone | 336-679-2386
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Fax | 336-679-4510
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Provider Business Mailing Address
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Address Line | 2979 PGA BLVD
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-2911
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Country | US
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Telephone | 561-627-0664
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Fax | 561-627-2867
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Authorized Official
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Title or Position | CEO
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Name | MR. PAUL WALCZAK
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Credential |
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Telephone | 561-627-0664
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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-099-008
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License Number State | NC
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