Provider Demographics
NPI:1467588699
Name:KANNAPOLIS HOLDINGS LLC
Entity Type:Organization
Organization Name:KANNAPOLIS HOLDINGS LLC
Other - Org Name:KANNAPOLIS VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-738-3046
Mailing Address - Street 1:1516 PINE ST
Mailing Address - Street 2:PO BOX 550
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-4142
Mailing Address - Country:US
Mailing Address - Phone:704-932-8900
Mailing Address - Fax:704-938-9334
Practice Address - Street 1:1516 PINE ST
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-4142
Practice Address - Country:US
Practice Address - Phone:704-932-8900
Practice Address - Fax:704-938-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL013033310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805585Medicaid