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General NPI Number Information
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NPI Number | 1720264146
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Entity Type | Organization
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Legal Business Name | KYRIE HEALTH PROPERTIES 1, LLC
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 1902 ORA DR
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City | STATESVILLE
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State | NC
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Zip | 28625-6343
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Country | US
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Telephone | 704-878-6376
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Fax |
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Provider Business Mailing Address
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Address Line | 1725 FRED HINSHAW RD
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City | YADKINVILLE
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State | NC
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Zip | 27055-7342
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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 | PRESIDENT
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Name | MARIANNE STAMEY
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Credential |
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Telephone | 336-849-4051
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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 | HAL049026
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License Number State | NC
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