MEDICARE: APPLEWOOD ASSISTED 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	HAL098-019	NC

General Provider Information

NPI Number	:	1770649493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLEWOOD ASSISTED LIVING LLC

Provider Business Mailing Address
First Line	:	PO BOX 100
Second Line	:
City	:	ELM CITY
State	:	NC
Zip	:	27822-0100
Country	:	US
Telephone Number	:	252-236-4085
Fax Number	:	252-236-3596

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	:	252-236-4085
Fax Number	:	252-236-3596

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. GAIL D. TITUES
Credential	:
Telephone Number	:	252-236-4085

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/09/2008

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Directions to “APPLEWOOD ASSISTED LIVING LLC ” Practice Location

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