Provider Demographics
NPI:1902087760
Name:CEDAR ROCK OF MOCKSVILLE, LLC
Entity Type:Organization
Organization Name:CEDAR ROCK OF MOCKSVILLE, LLC
Other - Org Name:DBA CEDAR ROCK ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-595-6004
Mailing Address - Street 1:PO BOX 1487
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27285-1487
Mailing Address - Country:US
Mailing Address - Phone:336-595-1075
Mailing Address - Fax:
Practice Address - Street 1:191 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2643
Practice Address - Country:US
Practice Address - Phone:336-751-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility