Provider Demographics
NPI:1437217981
Name:LOVING CARE ASSISTED LIVING INC
Entity Type:Organization
Organization Name:LOVING CARE ASSISTED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:BA DEGREE
Authorized Official - Phone:919-258-3953
Mailing Address - Street 1:PO BOX 4911
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331
Mailing Address - Country:US
Mailing Address - Phone:919-258-3953
Mailing Address - Fax:919-258-5872
Practice Address - Street 1:544 COX MADDOX RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330
Practice Address - Country:US
Practice Address - Phone:919-258-5600
Practice Address - Fax:919-258-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-053-018310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805474Medicaid