MEDICARE: CB SENIOR LIVING, 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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1497442073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CB SENIOR LIVING, LLC

Provider Business Mailing Address
First Line	:	115 ILILDA DR
Second Line	:
City	:	HERTFORD
State	:	NC
Zip	:	27944-9560
Country	:	US
Telephone Number	:	252-333-2909
Fax Number	:

Provider Business Practice Location Address
First Line	:	1361 CAROLINA REST HOME RD
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-8653
Country	:	US
Telephone Number	:	252-333-2909
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MS. CATHERINE ELIZABETH ARMSTRONG
Credential	:
Telephone Number	:	252-333-2909

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	04/24/2023

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