Provider Demographics
NPI:1730192238
Name:CLINTON HOLDINGS LLC
Entity type:Organization
Organization Name:CLINTON HOLDINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:TREFZGER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:828-324-8898
Mailing Address - Street 1:495 ZION HILL RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-6304
Mailing Address - Country:US
Mailing Address - Phone:828-738-3053
Mailing Address - Fax:828-738-0350
Practice Address - Street 1:205 MARTHA LN
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-9639
Practice Address - Country:US
Practice Address - Phone:910-592-0154
Practice Address - Fax:910-592-6361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-082-015310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805562Medicaid