Provider Demographics
NPI:1235305343
Name:EC LITTLE AVENUE OPERATIONS, LLC
Entity Type:Organization
Organization Name:EC LITTLE AVENUE OPERATIONS, LLC
Other - Org Name:ELMCROFT OF LITTLE AVENUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:MULLOY
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:502-753-6001
Mailing Address - Street 1:9510 ORMSBY STATION RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4081
Mailing Address - Country:US
Mailing Address - Phone:502-753-6000
Mailing Address - Fax:502-753-6100
Practice Address - Street 1:7745 LITTLE AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8168
Practice Address - Country:US
Practice Address - Phone:704-541-9333
Practice Address - Fax:704-541-5358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-060-082311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home