Provider Demographics
NPI:1265738157
Name:WEST BLADEN ASSISTED LIVING, LLC
Entity type:Organization
Organization Name:WEST BLADEN ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-256-5989
Mailing Address - Street 1:714 BLADEN STREET
Mailing Address - Street 2:
Mailing Address - City:BLADENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28320
Mailing Address - Country:US
Mailing Address - Phone:910-863-4500
Mailing Address - Fax:910-863-3142
Practice Address - Street 1:714 BLADEN STREET
Practice Address - Street 2:
Practice Address - City:BLADENBORO
Practice Address - State:NC
Practice Address - Zip Code:28320
Practice Address - Country:US
Practice Address - Phone:910-863-4500
Practice Address - Fax:910-863-3142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-009-025311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home