Provider Demographics
NPI:1154078715
Name:ALBERTACARE, LLC
Entity Type:Organization
Organization Name:ALBERTACARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TARSHIA
Authorized Official - Middle Name:MCCRAY
Authorized Official - Last Name:PULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-916-7783
Mailing Address - Street 1:9121 ANSON WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5857
Mailing Address - Country:US
Mailing Address - Phone:919-916-7783
Mailing Address - Fax:
Practice Address - Street 1:519 E CLUB BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-4501
Practice Address - Country:US
Practice Address - Phone:919-908-6480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBERTACARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMHL-032-622OtherFACILITY LICENSE NUMBER