Provider Demographics
NPI:1528167095
Name:CLAPP'S ASSISTED LIVING
Entity type:Organization
Organization Name:CLAPP'S ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:CLAPP
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-674-2252
Mailing Address - Street 1:4558 PLEASANT GARDEN ROAD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27313
Mailing Address - Country:US
Mailing Address - Phone:336-674-2252
Mailing Address - Fax:336-674-3591
Practice Address - Street 1:4558 PLEASANT GARDEN ROAD
Practice Address - Street 2:
Practice Address - City:PLEASANT GARDEN
Practice Address - State:NC
Practice Address - Zip Code:27313
Practice Address - Country:US
Practice Address - Phone:336-674-2252
Practice Address - Fax:336-674-3591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-041-054310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805434Medicaid