Provider Demographics
NPI:1598962516
Name:CANDLER LIVING CENTER LLC
Entity Type:Organization
Organization Name:CANDLER LIVING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-738-3046
Mailing Address - Street 1:495 ZION HILL RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-6304
Mailing Address - Country:US
Mailing Address - Phone:828-738-3046
Mailing Address - Fax:828-738-0350
Practice Address - Street 1:136 ROBINSON COVE ROAD
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715
Practice Address - Country:US
Practice Address - Phone:828-738-3046
Practice Address - Fax:828-738-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL 011 250310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHAL 011 250OtherLICENSE