Basic Information
| Provider Information | |||||||||
| NPI: | 1750952438 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EC OPCO SOUTHERN PINES, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5885 MEADOWS RD STE 500 | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970358646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712134234 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 BRUCEWOOD RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHERN PINES | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283875159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106924928 | ||||||||
| FaxNumber: | 9106920899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2021 | ||||||||
| LastUpdateDate: | 07/05/2021 | ||||||||
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| AuthorizedOfficialLastName: | FLEMING | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTROLLER OF MANAGEMENT COMPANY | ||||||||
| AuthorizedOfficialTelephone: | 9712273922 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311Z00000X | N | Nursing & Custodial Care Facilities | Custodial Care Facility | 311ZA0620X | N | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.