Provider Demographics
NPI:1386839868
Name:STEWART, SUSAN RAY (AMINISTRATOR)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RAY
Last Name:STEWART
Suffix:
Gender:F
Credentials:AMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4159 BRANDON LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-7755
Mailing Address - Country:US
Mailing Address - Phone:336-570-1748
Mailing Address - Fax:336-570-0905
Practice Address - Street 1:4159 BRANDON LN
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-7755
Practice Address - Country:US
Practice Address - Phone:336-570-1748
Practice Address - Fax:336-570-0905
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL001121311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility