Basic Information
| Provider Information | |||||||||
| NPI: | 1891906194 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HELTON MANOR WEST ASSISTED LIVING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 MONTANA DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282163604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043932870 | ||||||||
| FaxNumber: | 7043933476 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 MONTANA DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282163604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043932870 | ||||||||
| FaxNumber: | 7043933476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MENDINGHALL | ||||||||
| AuthorizedOfficialFirstName: | HARRIETT | ||||||||
| AuthorizedOfficialMiddleName: | PLATT | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7043932870 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | HAL 060-074 | NC | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 7805203 | 05 | NC | MEDICAID |