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General NPI Number Information
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NPI Number | 1881330207
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Entity Type | Organization
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Legal Business Name | MORGANTON GERIATRIC LLC
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 125 CAMELLIA GARDEN ST
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City | MORGANTON
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State | NC
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Zip | 28655-8207
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Country | US
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Telephone | 828-433-5875
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Fax | 828-433-7022
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Provider Business Mailing Address
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Address Line | 1121 BALTUSROL LN
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City | WAXHAW
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State | NC
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Zip | 28173-9031
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Country | US
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Telephone | 704-989-5736
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | PHANI MOHAN VUPADHYAYULA
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Credential | MD
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Telephone | 704-989-5736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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