Provider Demographics
NPI:1093858623
Name:ORIOLE PLACE ADULT CARE HOME
Entity Type:Organization
Organization Name:ORIOLE PLACE ADULT CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:M
Authorized Official - Last Name:PHILIPPE-AUGUSTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-494-4731
Mailing Address - Street 1:3505 ORIOLE PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1214
Mailing Address - Country:US
Mailing Address - Phone:704-494-4731
Mailing Address - Fax:704-494-4731
Practice Address - Street 1:3505 ORIOLE PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1214
Practice Address - Country:US
Practice Address - Phone:704-494-4731
Practice Address - Fax:704-494-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-060-0843104A0625X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)