Provider Demographics
NPI:1225306731
Name:INDEPENDENT HEALING LLC
Entity Type:Organization
Organization Name:INDEPENDENT HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:BALLARD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:866-825-5057
Mailing Address - Street 1:811 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-6865
Mailing Address - Country:US
Mailing Address - Phone:866-825-5057
Mailing Address - Fax:
Practice Address - Street 1:811 S 12TH ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-6865
Practice Address - Country:US
Practice Address - Phone:866-825-5057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC311ZA0620X311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home