Basic Information
| Provider Information | |||||||||
| NPI: | 1962643411 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY ALTERNATIVE HOUSING | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1721 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283021721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104868989 | ||||||||
| FaxNumber: | 9104846033 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MICHAEL LN | ||||||||
| Address2: | |||||||||
| City: | ABERDEEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283152223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109441367 | ||||||||
| FaxNumber: | 9109441572 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2009 | ||||||||
| LastUpdateDate: | 03/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | NICHOLS ILL | ||||||||
| AuthorizedOfficialFirstName: | WILBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9104868989 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | III | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | FCL 026-033 | NC | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.