Provider Demographics
NPI:1326263864
Name:KNOXS HOUSE
Entity Type:Organization
Organization Name:KNOXS HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:704-475-5821
Mailing Address - Street 1:2918 DUCK POINT DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-8813
Mailing Address - Country:US
Mailing Address - Phone:704-475-5821
Mailing Address - Fax:704-475-7207
Practice Address - Street 1:3311 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-8988
Practice Address - Country:US
Practice Address - Phone:704-475-5821
Practice Address - Fax:704-475-7207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL090026376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty