1972823243 NPI number — MCCRACKEN REST HOME

Table of content: (NPI 1972823243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972823243 NPI number — MCCRACKEN REST HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCRACKEN REST HOME
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:
JUDY LAWTON
Provider Other Organization Name Type Code:
3
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:
1972823243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1534
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE JUNALUSKA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28745-1534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-550-7913
Provider Business Mailing Address Fax Number:
828-452-1813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 MCCRACKEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28786-4631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-550-7913
Provider Business Practice Location Address Fax Number:
828-452-1813
Provider Enumeration Date:
06/09/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAWTON
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
828-550-7913

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  HAL044028 , 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)