1972641199 NPI number — SPRINGVIEW SENIOR LIVING INC

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 1972641199 NPI number — SPRINGVIEW SENIOR LIVING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRINGVIEW SENIOR LIVING INC
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:
1972641199
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2175
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27216-2175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-222-8913
Provider Business Mailing Address Fax Number:
336-222-1935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
613 W WHITSETT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27253-1635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-222-8913
Provider Business Practice Location Address Fax Number:
336-222-1935
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCHUGH
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
DIX
Authorized Official Title or Position:
OWNER ADMINISTRATOR
Authorized Official Telephone Number:
336-222-8913

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  HAL001025 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7803938 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: HAL-001-162 . This is a "NC DIVISION OF HEALTH SERVICE REGULATION" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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