Provider Demographics
NPI: | 1396399531 |
---|---|
Name: | CITIZENS SENIOR LIVING INC |
Entity Type: | Organization |
Organization Name: | CITIZENS SENIOR LIVING INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO/ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DANIEL |
Authorized Official - Middle Name: | ARCHIBONG |
Authorized Official - Last Name: | JACK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CEO |
Authorized Official - Phone: | 919-633-9397 |
Mailing Address - Street 1: | 4012 BURLINGTON MILLS RD APT 2B |
Mailing Address - Street 2: | |
Mailing Address - City: | WAKE FOREST |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27587-9103 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 919-633-9397 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5540 CENTERVIEW DR STE 200 |
Practice Address - Street 2: | |
Practice Address - City: | RALEIGH |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27606-3386 |
Practice Address - Country: | US |
Practice Address - Phone: | 919-276-4602 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-07-25 |
Last Update Date: | 2020-03-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health | ||
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Single Specialty | |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Single Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Single Specialty | |
No | 251F00000X | Agencies | Home Infusion | ||
No | 251G00000X | Agencies | Hospice Care, Community Based | ||
No | 251J00000X | Agencies | Nursing Care | ||
No | 251S00000X | Agencies | Community/Behavioral Health | ||
No | 261QI0500X | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | |
No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | |
No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
No | 283X00000X | Hospitals | Rehabilitation Hospital | ||
No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness | |
No | 3140N1450X | Nursing & Custodial Care Facilities | Skilled Nursing Facility | Nursing Care, Pediatric | |
No | 332BX2000X | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |