Provider Demographics
NPI:1073558706
Name:SPRING ARBOR OF DURHAM LTD PATNERSHIP
Entity Type:Organization
Organization Name:SPRING ARBOR OF DURHAM LTD PATNERSHIP
Other - Org Name:SPRING ARBOR OF DURHAM
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CRITTENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-403-0055
Mailing Address - Street 1:4523 HOPE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5613
Mailing Address - Country:US
Mailing Address - Phone:919-403-0055
Mailing Address - Fax:919-403-5667
Practice Address - Street 1:4523 HOPE VALLEY RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5613
Practice Address - Country:US
Practice Address - Phone:919-403-0055
Practice Address - Fax:919-403-5667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-032-013310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802738Medicaid