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General NPI Number Information
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NPI Number | 1902391915
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Entity Type | Organization
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Legal Business Name | COMMON GROUND LIVING LLC
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 06/22/2018
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Provider Practice Location Address
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Address Line | 1616 RIVERKNOLL DR
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City | RALEIGH
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State | NC
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Zip | 27610-4580
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Country | US
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Telephone | 919-696-1772
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Fax |
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Provider Business Mailing Address
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Address Line | 201 PARK AT NORTH HILLS APT 410
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City | RALEIGH
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State | NC
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Zip | 27609
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Country | US
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Telephone | 919-696-1772
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DANA JACKSON BARNES
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Credential | BS
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Telephone | 919-696-1772
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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 | 7806157
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License Number State | NC
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