=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871712182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MITCHELL HEIGHTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2007
-----------------------------------------------------
Last Update Date | 01/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 KUYKENDALL BRANCH RD
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28804-9612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-645-3094
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1807
-----------------------------------------------------
City | LEICESTER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-645-3094
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LARRY D MITCHELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-645-3094
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | FCL-011-260
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | FCL-011-261
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------