Provider Demographics
NPI:1508201112
Name:NANA'S ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:NANA'S ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPEATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:RIPPY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-527-6606
Mailing Address - Street 1:133 BANKROFT CT
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7628
Mailing Address - Country:US
Mailing Address - Phone:910-527-6606
Mailing Address - Fax:910-527-6606
Practice Address - Street 1:1114 MONTREAT RD
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-3232
Practice Address - Country:US
Practice Address - Phone:910-527-6606
Practice Address - Fax:910-527-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL011331310400000X
NCHAL045116310400000X
NCHAL045117310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility