Basic Information
| Provider Information | |||||||||
| NPI: | 1679942411 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MPV ENTERPRISES, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | D/B/A THE LIVING CENTER OF CONCORD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1487 | ||||||||
| Address2: | |||||||||
| City: | KERNERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272851487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365951075 | ||||||||
| FaxNumber: | 3365951078 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 WARREN C COLEMAN BLVD N | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280276786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047934760 | ||||||||
| FaxNumber: | 7047934764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2015 | ||||||||
| LastUpdateDate: | 09/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | MCMANUS | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9802011631 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | HAL-013-044 | NC | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.