Provider Demographics
NPI:1639212764
Name:PIEDMONT ADULT LIVING SERVICES, INC.
Entity Type:Organization
Organization Name:PIEDMONT ADULT LIVING SERVICES, INC.
Other - Org Name:PALS ADULT DAY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTYE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:BACHLOR IN NURSING,
Authorized Official - Phone:704-370-0093
Mailing Address - Street 1:1201 SOUTH BLVD
Mailing Address - Street 2:PO BOX 669385
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4207
Mailing Address - Country:US
Mailing Address - Phone:704-370-0093
Mailing Address - Fax:704-370-0940
Practice Address - Street 1:1201 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4207
Practice Address - Country:US
Practice Address - Phone:704-370-0093
Practice Address - Fax:704-370-0940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QA600X261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherADULT DAY HEALTH CENTER