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General NPI Number Information
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NPI Number | 1932413085
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Entity Type | Organization
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Legal Business Name | BLACKWELL-RANKIN INC
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Dates
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Enumeration Date | 07/31/2010
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Last Update Date | 07/31/2010
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Provider Practice Location Address
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Address Line | 348 ZEB RD
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City | GIBSONVILLE
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State | NC
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Zip | 27249-9507
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Country | US
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Telephone | 336-215-8866
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Fax | 336-349-7985
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Provider Business Mailing Address
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Address Line | PO BOX 155
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City | REIDSVILLE
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State | NC
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Zip | 27323-0155
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Country | US
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Telephone | 336-215-8866
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Fax | 336-349-7985
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Authorized Official
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Title or Position | OWNER, ADMINISTRATOR
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Name | MRS. SHUVON LEVETTE BLACKWELL-RANKIN
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Credential | RN
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Telephone | 336-215-8866
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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 | FCL079078
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License Number State | NC
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