Provider Demographics
NPI:1366590614
Name:COVENTRY HOUSE OF SILER CITY
Entity type:Organization
Organization Name:COVENTRY HOUSE OF SILER CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-742-4052
Mailing Address - Street 1:260 VILLAGE LAKE RD
Mailing Address - Street 2:PO BOX 707
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-1820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:260 VILLAGE LAKE RD
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-1820
Practice Address - Country:US
Practice Address - Phone:919-742-4052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-019-018310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805370OtherPROVIDER NUMBER