Provider Demographics
NPI:1295821130
Name:HUNTERSVILLE OAKS NURSING HOME
Entity Type:Organization
Organization Name:HUNTERSVILLE OAKS NURSING HOME
Other - Org Name:HUNTERSVILLE OAKS NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOWDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:704-875-7400
Mailing Address - Street 1:12019 VERHOEFF DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-9217
Mailing Address - Country:US
Mailing Address - Phone:704-512-6438
Mailing Address - Fax:704-512-6485
Practice Address - Street 1:13001 OLD STATESVILLE RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8981
Practice Address - Country:US
Practice Address - Phone:704-875-7400
Practice Address - Fax:704-874-7490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0469950001Medicare NSC