Provider Demographics
NPI:1326178708
Name:TRYON COLUMBUS RETIREMENT ASSOCIATES, LLC
Entity Type:Organization
Organization Name:TRYON COLUMBUS RETIREMENT ASSOCIATES, LLC
Other - Org Name:LAURELWOODS ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FREDDIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-894-3900
Mailing Address - Street 1:1062 W MILLS ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-8635
Mailing Address - Country:US
Mailing Address - Phone:828-894-3900
Mailing Address - Fax:828-894-8290
Practice Address - Street 1:1062 W MILLS ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-8635
Practice Address - Country:US
Practice Address - Phone:828-894-3900
Practice Address - Fax:828-894-8290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-075-005310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804629Medicaid