Provider Demographics
NPI:1184814600
Name:GOLDSBORO ASSISTED LIVING,LLC
Entity Type:Organization
Organization Name:GOLDSBORO ASSISTED LIVING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-922-0124
Mailing Address - Street 1:2201 ROYALL AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-7409
Mailing Address - Country:US
Mailing Address - Phone:919-735-7684
Mailing Address - Fax:919-735-8552
Practice Address - Street 1:2201 ROYALL AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-7409
Practice Address - Country:US
Practice Address - Phone:919-735-7684
Practice Address - Fax:919-735-8552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL096031310400000X, 311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)