Basic Information
| Provider Information | |||||||||
| NPI: | 1891159315 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RAINTREE HEALTHCARE OF PARKTON LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PARKTON PLACE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7209 E WT HARRIS BLVD STE 219 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282271063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042808339 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1165 WEST PARKTON TOBERMORY RD | ||||||||
| Address2: | |||||||||
| City: | PARKTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283719664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042808340 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2016 | ||||||||
| LastUpdateDate: | 04/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | BUTLER | ||||||||
| AuthorizedOfficialFirstName: | DANYELL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7042808339 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | HAL-078-110 | NC | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.