Provider Demographics
NPI:1649390287
Name:CAMBRIDGE HILLS ASSISTED LIVING INC
Entity Type:Organization
Organization Name:CAMBRIDGE HILLS ASSISTED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-598-4697
Mailing Address - Street 1:5660 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27574-7958
Mailing Address - Country:US
Mailing Address - Phone:336-598-4697
Mailing Address - Fax:336-598-4698
Practice Address - Street 1:5660 DURHAM RD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27574-7958
Practice Address - Country:US
Practice Address - Phone:336-598-4697
Practice Address - Fax:336-598-4698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-073-003310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803916Medicaid