Basic Information
| Provider Information | |||||||||
| NPI: | 1114015310 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRING ARBOR OF HICKORY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2010 29TH AVENUE DR NE | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286017517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283267200 | ||||||||
| FaxNumber: | 8282610055 | ||||||||
| Practice Location | |||||||||
| Address1: | 2010 29TH AVENUE DR NE | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286017517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283267200 | ||||||||
| FaxNumber: | 8282610055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WEST | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8283267200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | HAL-018-007 | NC | X | Nursing & Custodial Care Facilities | Assisted Living Facility | 311500000X | HAL-018-007 | NC | X | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) |
ID Information
| ID | Type | State | Issuer | Description | 7802976 | 05 | NC | MEDICAID |