Provider Demographics
NPI:1174863500
Name:EARL ENTERPRISES INC.
Entity Type:Organization
Organization Name:EARL ENTERPRISES INC.
Other - Org Name:SPICEWOOD COTTAGES WILLOWS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:828-456-8365
Mailing Address - Street 1:251 SHELTON ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3362
Mailing Address - Country:US
Mailing Address - Phone:828-456-8365
Mailing Address - Fax:828-456-6792
Practice Address - Street 1:65 LOVING WAY
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-9471
Practice Address - Country:US
Practice Address - Phone:828-452-0913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EARL ENTERPRISES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-044-041310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7806695Medicaid