Provider Demographics
NPI:1083360689
Name:RSS/KING OPERATIONS, LLC
Entity Type:Organization
Organization Name:RSS/KING OPERATIONS, LLC
Other - Org Name:PRIDDY MANOR ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNILEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-371-4233
Mailing Address - Street 1:5430 WADE PARK BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-4191
Mailing Address - Country:US
Mailing Address - Phone:919-371-4233
Mailing Address - Fax:
Practice Address - Street 1:1294 PRIDDY RD
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-7485
Practice Address - Country:US
Practice Address - Phone:336-331-5953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home