MEDICARE: ELKIN RETIREMENT COMMUNITY, 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
2	310400000X	Assisted Living Facility	HAL-086-013	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	:	1952545592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELKIN RETIREMENT COMMUNITY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 814
Second Line	:
City	:	RANDLEMAN
State	:	NC
Zip	:	27317-0814
Country	:	US
Telephone Number	:	336-495-2700
Fax Number	:	336-495-5552

Provider Business Practice Location Address
First Line	:	500 JOHNSON RIDGE RD
Second Line	:
City	:	ELKIN
State	:	NC
Zip	:	28621-2420
Country	:	US
Telephone Number	:	336-835-6672
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DAVID DEAN WILSON
Credential	:
Telephone Number	:	336-495-2700

Provider Enumeration Date	:	04/27/2009
Last Update Date	:	06/13/2013

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