Basic Information
| Provider Information | |||||||||
| NPI: | 1548521115 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MITCHELL HOUSE ONE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MITCHELL HOUSE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 962 WAYNE AVE | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209104433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2408412919 | ||||||||
| FaxNumber: | 2408412630 | ||||||||
| Practice Location | |||||||||
| Address1: | 13681 HWY 226 SOUTH | ||||||||
| Address2: | |||||||||
| City: | SPRUCE PINE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287667771 | ||||||||
| FaxNumber: | 8287665862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2012 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | TREFZGER | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8283225535 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | HAL-061-011 | NC | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 343900000X | N | Transportation Services | Non-emergency Medical Transport (VAN) | 311ZA0620X | Y | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
No ID Information.