Provider Demographics
NPI:1184220873
Name:ASHEVILLE GERIATRIC LLC
Entity Type:Organization
Organization Name:ASHEVILLE GERIATRIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHANI
Authorized Official - Middle Name:MOHAN
Authorized Official - Last Name:VUPADHYAYULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:704-989-5736
Mailing Address - Street 1:95 RICHMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3918
Mailing Address - Country:US
Mailing Address - Phone:704-989-5736
Mailing Address - Fax:
Practice Address - Street 1:95 RICHMOND HILL RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-3918
Practice Address - Country:US
Practice Address - Phone:704-989-5736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home