Provider Demographics
NPI:1275681215
Name:NCAL- ACQUISITION I, INC.
Entity Type:Organization
Organization Name:NCAL- ACQUISITION I, INC.
Other - Org Name:SOMERSET COURT OF HAMLET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-724-1000
Mailing Address - Street 1:1105 BROOKSTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2524
Mailing Address - Country:US
Mailing Address - Phone:336-724-1000
Mailing Address - Fax:336-724-9955
Practice Address - Street 1:632 FREEMAN MILL RD
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-7163
Practice Address - Country:US
Practice Address - Phone:910-582-0082
Practice Address - Fax:910-582-8567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-077-009310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803742Medicaid