NPI 1124191804

Statesville Assisted Living

Organisation Preferred Provider Organization Statesville, NC

Practice location

Address: 2147 Davie Ave, Statesville, NC 28625-9200
Phone: (704) 878-0123
Fax: (704) 878-8689

Authorised official

Name: Aldo Baccala
Title: Execuitve Officer
Phone: (707) 778-6719

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence HAL-049-023 (NC)

Other Preferred Provider Organization providers in North Carolina →

Registry record

NPI: 1124191804
Entity type: Organization
NPI issued: 17 Nov 2006
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.