Provider Demographics
NPI:1609233295
Name:MODERATE LIVING FOR THE AGING INC
Entity Type:Organization
Organization Name:MODERATE LIVING FOR THE AGING INC
Other - Org Name:MT. GILEAD INDEPENDENT SENIOR AND ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MYSTERY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-439-1669
Mailing Address - Street 1:PO BOX 1312
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27306-1312
Mailing Address - Country:US
Mailing Address - Phone:910-439-1669
Mailing Address - Fax:888-351-5666
Practice Address - Street 1:110 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:NC
Practice Address - Zip Code:27306-9606
Practice Address - Country:US
Practice Address - Phone:910-439-1635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90368261Q00000X
NC902768310400000X
347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No347E00000XTransportation ServicesTransportation Broker