Provider Demographics
NPI:1376858696
Name:CROMARTIE /SPRING VILLAGE
Entity Type:Organization
Organization Name:CROMARTIE /SPRING VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:RABB
Authorized Official - Suffix:
Authorized Official - Credentials:NC ADMIN CERTIF
Authorized Official - Phone:910-865-5445
Mailing Address - Street 1:508 E. WORTH ST
Mailing Address - Street 2:
Mailing Address - City:ST. PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:38384
Mailing Address - Country:US
Mailing Address - Phone:910-865-5445
Mailing Address - Fax:910-488-2856
Practice Address - Street 1:508 E. WORTH ST
Practice Address - Street 2:
Practice Address - City:ST. PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384
Practice Address - Country:US
Practice Address - Phone:910-865-5445
Practice Address - Fax:910-488-2856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-078-082310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility