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General NPI Number Information
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NPI Number | 1699147314
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Entity Type | Organization
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Legal Business Name | LIFE STAGES ASSISTED LIVING LLC
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 424 GLOVENIA ST
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City | EDEN
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State | NC
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Zip | 27288-4844
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Country | US
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Telephone | 336-623-1093
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3066
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City | MARTINSVILLE
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State | VA
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Zip | 24115-3066
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Country | US
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Telephone | 732-330-8683
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TOREY MORRIS
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Credential |
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Telephone | 732-330-8683
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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 | FCL-079-100
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License Number State | NC
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