MEDICARE: ADORABLE 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
1	311ZA0620X	Adult Care Home Facility	HAL-068-034	NC

General Provider Information

NPI Number	:	1780127050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADORABLE SENIOR LIVING, INC

Provider Business Mailing Address
First Line	:	401 W QUEEN ST
Second Line	:
City	:	HILLSBOROUGH
State	:	NC
Zip	:	27278-2040
Country	:	US
Telephone Number	:	919-606-2013
Fax Number	:	919-876-4946

Provider Business Practice Location Address
First Line	:	1801 SAINT ALBANS DR STE G
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6286
Country	:	US
Telephone Number	:	919-606-2013
Fax Number	:	919-876-4949

Authorized Official
Title or Position	:	CFO TREASURER
Name	:	REGINALD CHINEDU OGBONNA
Credential	:
Telephone Number	:	919-732-4201

Provider Enumeration Date	:	11/18/2016
Last Update Date	:	11/18/2016

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