Provider Demographics
NPI:1548572357
Name:RAINTREE HEALTHCARE OF KANNAPOLIS LLC
Entity Type:Organization
Organization Name:RAINTREE HEALTHCARE OF KANNAPOLIS LLC
Other - Org Name:KANNAPOLIS VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:REEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-763-6300
Mailing Address - Street 1:2015 AYRSLEY TOWN BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4068
Mailing Address - Country:US
Mailing Address - Phone:704-280-8340
Mailing Address - Fax:704-973-4019
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:704-280-8340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility