Provider Demographics
NPI:1639298995
Name:WESTERN NORTH CAROLINA LIONS, INC.
Entity Type:Organization
Organization Name:WESTERN NORTH CAROLINA LIONS, INC.
Other - Org Name:MARJORIE MCCUNE MEMORIAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:ASSISTED LIVING ADM
Authorized Official - Phone:828-669-8452
Mailing Address - Street 1:101 LIONS WAY
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-2588
Mailing Address - Country:US
Mailing Address - Phone:828-669-8452
Mailing Address - Fax:828-669-2377
Practice Address - Street 1:101 LIONS WAY
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-2588
Practice Address - Country:US
Practice Address - Phone:828-669-8452
Practice Address - Fax:828-669-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-011-011310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC295ECS39Medicaid