MEDICARE: SPRING ARBOR ALBEMARLE NC TENANT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1023752094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING ARBOR ALBEMARLE NC TENANT, LLC

Provider Business Mailing Address
First Line	:	420 S ORANGE AVE STE 400
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-4908
Country	:	US
Telephone Number	:	407-250-7482
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 PARK RIDGE RD
Second Line	:
City	:	ALBEMARLE
State	:	NC
Zip	:	28001-2818
Country	:	US
Telephone Number	:	833-582-1430
Fax Number	:

Authorized Official
Title or Position	:	PARALEGAL
Name	:	AMY PATTERSON
Credential	:
Telephone Number	:	407-250-7482

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	04/26/2022

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