Provider Demographics
NPI:1235264037
Name:STOREY VILLA OF SHULER HEALTH CARE, INC.
Entity Type:Organization
Organization Name:STOREY VILLA OF SHULER HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SHULER
Authorized Official - Last Name:WHITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-996-0772
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27285-0548
Mailing Address - Country:US
Mailing Address - Phone:336-996-0772
Mailing Address - Fax:336-996-6225
Practice Address - Street 1:250 PITTS ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2670
Practice Address - Country:US
Practice Address - Phone:336-996-0772
Practice Address - Fax:336-996-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-034-013310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801551Medicaid