Provider Demographics
NPI:1508215054
Name:ALPHA CONCORD PLANTATION LLC
Entity Type:Organization
Organization Name:ALPHA CONCORD PLANTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:
Authorized Official - Last Name:OKWOSHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-819-3882
Mailing Address - Street 1:PO BOX 41153
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27629-1153
Mailing Address - Country:US
Mailing Address - Phone:919-819-3882
Mailing Address - Fax:919-295-1127
Practice Address - Street 1:2809 OLD CONCORD RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-1339
Practice Address - Country:US
Practice Address - Phone:704-680-2248
Practice Address - Fax:919-295-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-080-027310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility