Basic Information
| Provider Information | |||||||||
| NPI: | 1780020347 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STAYWELL SENIOR CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 809 CURRY DR | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272056715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366284200 | ||||||||
| FaxNumber: | 3366284235 | ||||||||
| Practice Location | |||||||||
| Address1: | 809 CURRY DR | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272056715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366284200 | ||||||||
| FaxNumber: | 3366284235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2013 | ||||||||
| LastUpdateDate: | 05/01/2014 | ||||||||
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| AuthorizedOfficialLastName: | MURPHY | ||||||||
| AuthorizedOfficialFirstName: | TRACEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3366284210 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251T00000X | H1533 | NC | Y | Agencies | PACE Provider Organization |
No ID Information.