Provider Demographics
NPI:1235460585
Name:NICKANE PROP. LLC
Entity Type:Organization
Organization Name:NICKANE PROP. LLC
Other - Org Name:NORTH RIDGE ASSISTED LIVING #5
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-216-8376
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-1810
Mailing Address - Country:US
Mailing Address - Phone:828-216-8376
Mailing Address - Fax:
Practice Address - Street 1:75 KUYKENDALL BRANCH RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-9612
Practice Address - Country:US
Practice Address - Phone:828-484-9813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-011-293310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility