Provider Demographics
NPI:1093867244
Name:SAINTES ASSISTED INDEPENDENT LIVING
Entity Type:Organization
Organization Name:SAINTES ASSISTED INDEPENDENT LIVING
Other - Org Name:FLOYD B MCKISSICK SR. ASSISTED LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:INEZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:MYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-456-2090
Mailing Address - Street 1:962 MANSON AXTELL RD
Mailing Address - Street 2:
Mailing Address - City:NORLINA
Mailing Address - State:NC
Mailing Address - Zip Code:27563-9451
Mailing Address - Country:US
Mailing Address - Phone:252-456-2060
Mailing Address - Fax:252-456-2795
Practice Address - Street 1:962 MANSON AXTELL RD
Practice Address - Street 2:
Practice Address - City:NORLINA
Practice Address - State:NC
Practice Address - Zip Code:27563-9451
Practice Address - Country:US
Practice Address - Phone:252-456-2060
Practice Address - Fax:252-456-2795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-093-003310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802731Medicaid