Provider Demographics
NPI:1417585332
Name:LEA, MARCIA (ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:LEA
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2304
Mailing Address - Country:US
Mailing Address - Phone:336-524-7618
Mailing Address - Fax:336-228-7900
Practice Address - Street 1:218 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2304
Practice Address - Country:US
Practice Address - Phone:336-524-7618
Practice Address - Fax:336-228-7900
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility