Provider Demographics
NPI:1093856114
Name:CARING HEARTS ASSISTED LIVING
Entity Type:Organization
Organization Name:CARING HEARTS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELOIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:SELLARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-228-7900
Mailing Address - Street 1:1209 ISLEY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-8240
Mailing Address - Country:US
Mailing Address - Phone:336-584-5176
Mailing Address - Fax:336-228-7900
Practice Address - Street 1:218 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2304
Practice Address - Country:US
Practice Address - Phone:336-228-7900
Practice Address - Fax:336-228-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL001104310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802358Medicaid