Provider Demographics
NPI:1477985893
Name:EARL ENTERPRISES INC
Entity Type:Organization
Organization Name:EARL ENTERPRISES INC
Other - Org Name:CREEKSIDE VILLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACI
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-456-8365
Mailing Address - Street 1:251 SHELTON ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3362
Mailing Address - Country:US
Mailing Address - Phone:828-456-8365
Mailing Address - Fax:828-597-0042
Practice Address - Street 1:465 BOYD AVE
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-4317
Practice Address - Country:US
Practice Address - Phone:828-456-9240
Practice Address - Fax:828-456-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-044-044311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHAL-044-044OtherNC DHHS LICENSE: