Provider Demographics
NPI:1558007658
Name:SPRING ARBOR WILSON NC TENANT, LLC
Entity Type:Organization
Organization Name:SPRING ARBOR WILSON NC TENANT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARALEGAL
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-250-7482
Mailing Address - Street 1:420 S ORANGE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-4908
Mailing Address - Country:US
Mailing Address - Phone:407-250-7482
Mailing Address - Fax:
Practice Address - Street 1:2045 WARD BLVD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-2873
Practice Address - Country:US
Practice Address - Phone:833-434-1160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility