Provider Demographics
NPI:1144574831
Name:THE PARTRIDGE GROUP, LLC
Entity Type:Organization
Organization Name:THE PARTRIDGE GROUP, LLC
Other - Org Name:THE PARTRIDGE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANILLYA
Authorized Official - Middle Name:WILKERSON
Authorized Official - Last Name:PARTRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-599-5777
Mailing Address - Street 1:131 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-5501
Mailing Address - Country:US
Mailing Address - Phone:336-599-5777
Mailing Address - Fax:
Practice Address - Street 1:131 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5501
Practice Address - Country:US
Practice Address - Phone:336-599-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-073-020311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home