Provider Demographics
NPI:1275763039
Name:LEA'S ASSISTED LIVING #1, INC.
Entity Type:Organization
Organization Name:LEA'S ASSISTED LIVING #1, INC.
Other - Org Name:FLOYD B. MCKISSICK SR. ASSISTED LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-456-2090
Mailing Address - Street 1:962 MANSON AXTELL RD
Mailing Address - Street 2:
Mailing Address - City:NORLINA
Mailing Address - State:NC
Mailing Address - Zip Code:27563-9451
Mailing Address - Country:US
Mailing Address - Phone:252-456-2090
Mailing Address - Fax:252-456-5118
Practice Address - Street 1:962 MANSON AXTELL RD
Practice Address - Street 2:
Practice Address - City:NORLINA
Practice Address - State:NC
Practice Address - Zip Code:27563-9451
Practice Address - Country:US
Practice Address - Phone:252-456-2090
Practice Address - Fax:252-456-5118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-093-009310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility