Provider Demographics
NPI:1598803082
Name:THE STAFFORD GROUP, INC.
Entity Type:Organization
Organization Name:THE STAFFORD GROUP, INC.
Other - Org Name:STAFFORD GLEN ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:BATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-752-3402
Mailing Address - Street 1:PO BOX 7386
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-7386
Mailing Address - Country:US
Mailing Address - Phone:252-752-3402
Mailing Address - Fax:252-754-2367
Practice Address - Street 1:2060 W 5TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-9160
Practice Address - Country:US
Practice Address - Phone:252-752-3402
Practice Address - Fax:252-754-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-074-030310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805410Medicaid