Basic Information
| Provider Information | |||||||||
| NPI: | 1598962516 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CANDLER LIVING CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 495 ZION HILL RD | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287526304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287383046 | ||||||||
| FaxNumber: | 8287380350 | ||||||||
| Practice Location | |||||||||
| Address1: | 136 ROBINSON COVE ROAD | ||||||||
| Address2: | |||||||||
| City: | CANDLER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287383046 | ||||||||
| FaxNumber: | 8287380350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HODGES | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER OPERATOR | ||||||||
| AuthorizedOfficialTelephone: | 8287383046 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | HAL 011 250 | NC | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | HAL 011 250 | 01 | NC | LICENSE | OTHER |