Provider Demographics
NPI:1538356175
Name:BLADENBORO ASSISTED LIVING
Entity type:Organization
Organization Name:BLADENBORO ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:910-863-3922
Mailing Address - Street 1:714 E BLADEN STREET
Mailing Address - Street 2:
Mailing Address - City:BLADENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28320-0669
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:910-863-2280
Practice Address - Street 1:2201 ROYALL AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-7409
Practice Address - Country:US
Practice Address - Phone:919-735-7684
Practice Address - Fax:919-735-8552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL009019310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility