Provider Demographics
NPI:1598014987
Name:SHELBY AL HOLDINGS, LLC
Entity Type:Organization
Organization Name:SHELBY AL HOLDINGS, LLC
Other - Org Name:SHELBY HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:TREFZGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-261-7309
Mailing Address - Street 1:1300 SPRING ST
Mailing Address - Street 2:SUTIE 205
Mailing Address - City:SILVER SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3654
Mailing Address - Country:US
Mailing Address - Phone:240-841-2919
Mailing Address - Fax:240-841-2630
Practice Address - Street 1:950 HARDIN DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3500
Practice Address - Country:US
Practice Address - Phone:704-480-9800
Practice Address - Fax:704-480-9803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-023-044310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility