Provider Demographics
NPI:1467839217
Name:CHATHAM RIDGE ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:CHATHAM RIDGE ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-993-7555
Mailing Address - Street 1:853 OLD WINSTON RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7143
Mailing Address - Country:US
Mailing Address - Phone:336-993-6111
Mailing Address - Fax:336-993-7555
Practice Address - Street 1:114 POLKS VILLAGE LANE
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27515
Practice Address - Country:US
Practice Address - Phone:919-918-7872
Practice Address - Fax:919-918-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL019021311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home