Provider Demographics
NPI:1164693818
Name:HOLDEN, MABLE DORIS (ADMINISTER)
Entity Type:Individual
Prefix:MS
First Name:MABLE
Middle Name:DORIS
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:ADMINISTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 ASHLAND DR
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-1901
Mailing Address - Country:US
Mailing Address - Phone:252-237-6523
Mailing Address - Fax:
Practice Address - Street 1:1607 ASHLAND DR
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-1901
Practice Address - Country:US
Practice Address - Phone:252-237-6523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC098119310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility