Provider Demographics
NPI:1164540225
Name:ELON VILLAGE HOMES, INC.
Entity Type:Organization
Organization Name:ELON VILLAGE HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT//ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:THURMAN
Authorized Official - Last Name:MOORE JR.
Authorized Official - Suffix:JR
Authorized Official - Credentials:ADMINISTRATOR, PRESI
Authorized Official - Phone:336-584-7930
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244
Mailing Address - Country:US
Mailing Address - Phone:336-584-7930
Mailing Address - Fax:336-584-0220
Practice Address - Street 1:715 E HAGGARD AVE.
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244
Practice Address - Country:US
Practice Address - Phone:336-584-7930
Practice Address - Fax:336-584-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL001009310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802245Medicaid