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NPI Code Detail

MEDICARE: CITIZENS SENIOR LIVING INC

MEDICARE: CITIZENS SENIOR LIVING INC
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
1104100000XSocial Worker
2106H00000XMarriage & Family Therapist
3224Z00000XOccupational Therapy Assistant
4251F00000XHome Infusion Agency
5251G00000XCommunity Based Hospice Care Agency
6251J00000XNursing Care Agency
7251S00000XCommunity/Behavioral Health Agency
8261QI0500XInfusion Therapy Clinic/Center
9261QP2000XPhysical Therapy Clinic/Center
10261QR0401XComprehensive Outpatient Rehabilitation Facility (CORF)
11283X00000XRehabilitation Hospital
123104A0625XAssisted Living Facility (Mental Illness)
133140N1450XPediatric Skilled Nursing Facility
14332BX2000XOxygen Equipment & Supplies (DME)
15251E00000XHome Health Agency

General Provider Information

NPI Number : 1396399531
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITIZENS SENIOR LIVING INC
Provider Business Mailing Address
First Line : 4012 BURLINGTON MILLS RD APT 2B
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-9103
Country : US
Telephone Number : 919-633-9397
Fax Number :
Provider Business Practice Location Address
First Line : 5540 CENTERVIEW DR STE 200
Second Line :
City : RALEIGH
State : NC
Zip : 27606-3386
Country : US
Telephone Number : 919-276-4602
Fax Number :
Authorized Official
Title or Position : CEO/ADMINISTRATOR
Name : DANIEL ARCHIBONG JACK
Credential : CEO
Telephone Number : 919-633-9397
Provider Enumeration Date : 07/25/2019
Last Update Date : 03/06/2020

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Directions to “CITIZENS SENIOR LIVING INC ” Practice Location

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