Basic Information
| Provider Information | |||||||||
| NPI: | 1972837631 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOORESVILLE SENIOR LIVING, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHURCHILL SENIOR LIVING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3723 FAIRVIEW INDUSTRIAL DR SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973021177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033759016 | ||||||||
| FaxNumber: | 5034851279 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 CARRIAGE CLUB DR | ||||||||
| Address2: | |||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281179284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046581200 | ||||||||
| FaxNumber: | 5034851279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2009 | ||||||||
| LastUpdateDate: | 09/29/2009 | ||||||||
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| AuthorizedOfficialLastName: | DUNN | ||||||||
| AuthorizedOfficialFirstName: | SHIRLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CRO REPRESENTATIVE | ||||||||
| AuthorizedOfficialTelephone: | 5034854948 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311500000X | HAL-049-025 | NC | N | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) | 310400000X | HAL-049-025 | NC | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.