MEDICARE: EMERALD OAKS HEALTHCARE, 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	HAL 098-028	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679881932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD OAKS HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	416 N PARKER ST
Second Line	:
City	:	ELM CITY
State	:	NC
Zip	:	27822-9217
Country	:	US
Telephone Number	:	252-245-3031
Fax Number	:	252-245-3033

Provider Business Practice Location Address
First Line	:	416 N PARKER ST
Second Line	:
City	:	ELM CITY
State	:	NC
Zip	:	27822-9217
Country	:	US
Telephone Number	:	252-245-3031
Fax Number	:	252-245-3033

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MRS. PAULA ARMSTRONG
Credential	:
Telephone Number	:	252-245-3031

Provider Enumeration Date	:	09/21/2010
Last Update Date	:	07/25/2011

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