Provider Demographics
NPI:1235238957
Name:LANDMARK ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:LANDMARK ASSISTED LIVING LLC
Other - Org Name:LANDMARK ESTATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:EVLEYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-752-2751
Mailing Address - Street 1:2959 SOWERS RD
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:27299-9351
Mailing Address - Country:US
Mailing Address - Phone:336-752-2751
Mailing Address - Fax:336-752-2410
Practice Address - Street 1:6781 OLD US HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-5336
Practice Address - Country:US
Practice Address - Phone:336-752-2751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801233Medicaid