Provider Demographics
NPI:1154457158
Name:THE R. A. GROUP, INC
Entity Type:Organization
Organization Name:THE R. A. GROUP, INC
Other - Org Name:GOLDEN YEARS ASSISTED LIVING II
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ADA
Authorized Official - Middle Name:EVELYN
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-227-5854
Mailing Address - Street 1:205B E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5730
Mailing Address - Country:US
Mailing Address - Phone:336-227-5854
Mailing Address - Fax:336-222-9068
Practice Address - Street 1:205B E 6TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5730
Practice Address - Country:US
Practice Address - Phone:336-227-5854
Practice Address - Fax:336-222-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-001-099311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHAL-001-099Medicaid