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General NPI Number Information
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NPI Number | 1699338327
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Entity Type | Organization
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Legal Business Name | ULTIMATE CARE ASSISTED LIVING FACILITY
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Dates
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Enumeration Date | 04/18/2019
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Last Update Date | 04/18/2019
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Provider Practice Location Address
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Address Line | 104 THE BLVD
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City | EDEN
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State | NC
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Zip | 27288-4704
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Country | US
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Telephone | 352-219-2262
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Fax |
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Provider Business Mailing Address
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Address Line | 1203 IRVING AVE
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City | EDEN
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State | NC
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Zip | 27288-5541
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HALICIA THOMPSON
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Credential |
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Telephone | 336-327-2861
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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 |
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License Number State |
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