1700620747 NPI number — HOME ASSISTED LIVING OPPORTUNITIES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700620747 NPI number — HOME ASSISTED LIVING OPPORTUNITIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME ASSISTED LIVING OPPORTUNITIES 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:
6
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:
1700620747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 SAINT GEORGE SQUARE CT STE 361
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27103-1368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-510-9838
Provider Business Mailing Address Fax Number:
256-325-5026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 SAINT GEORGE SQUARE CT STE 361
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-1368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-510-9838
Provider Business Practice Location Address Fax Number:
256-325-5026
Provider Enumeration Date:
06/24/2024

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
SHAMICA
Authorized Official Middle Name:
LONETTE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
573-510-9838

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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