Provider Demographics
NPI:1356489843
Name:BLAIR ASSISTED LIVING INC
Entity Type:Organization
Organization Name:BLAIR ASSISTED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUJAHED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-318-9667
Mailing Address - Street 1:PO BOX 2342
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28353-2342
Mailing Address - Country:US
Mailing Address - Phone:910-318-9667
Mailing Address - Fax:910-276-9223
Practice Address - Street 1:301 MCLAURIN AVE
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3621
Practice Address - Country:US
Practice Address - Phone:910-318-9667
Practice Address - Fax:910-276-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-083-010311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805184Medicaid