Provider Demographics
NPI:1073803854
Name:CHLORIS GAIL ATKINSON
Entity Type:Organization
Organization Name:CHLORIS GAIL ATKINSON
Other - Org Name:ST. MARY ROSA'S FAMILY CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHLORIS
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-274-0065
Mailing Address - Street 1:483 CARIBOU RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1616
Mailing Address - Country:US
Mailing Address - Phone:828-274-0065
Mailing Address - Fax:828-274-0065
Practice Address - Street 1:483 CARIBOU RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1616
Practice Address - Country:US
Practice Address - Phone:828-274-0065
Practice Address - Fax:828-274-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1073803854Medicaid