1821510090 NPI number — HUNTER HILL SENIOR LIVING, LLC

Table of content: MATTHEW FERGUSON PT, DPT (NPI 1306236831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821510090 NPI number — HUNTER HILL SENIOR LIVING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUNTER HILL SENIOR LIVING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821510090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
891 NOELL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY MOUNT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27804-1742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-443-7144
Provider Business Mailing Address Fax Number:
252-443-2319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
891 NOELL LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27804-1742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-443-7144
Provider Business Practice Location Address Fax Number:
252-443-2319
Provider Enumeration Date:
07/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
252-443-7144

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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