Provider Demographics
NPI:1659580819
Name:STATESVILLE ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:STATESVILLE ASSISTED LIVING, LLC
Other - Org Name:THE GARDENS OF STATESVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, NHA, FACHE
Authorized Official - Phone:704-878-0123
Mailing Address - Street 1:2147 DAVIE AVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-9200
Mailing Address - Country:US
Mailing Address - Phone:704-878-0123
Mailing Address - Fax:704-878-8689
Practice Address - Street 1:2147 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-9200
Practice Address - Country:US
Practice Address - Phone:704-878-0123
Practice Address - Fax:704-878-8689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL049023310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility