Provider Demographics
NPI:1679881932
Name:EMERALD OAKS HEALTHCARE, LLC
Entity Type:Organization
Organization Name:EMERALD OAKS HEALTHCARE, LLC
Other - Org Name:ELM CITY ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-245-3031
Mailing Address - Street 1:416 N PARKER ST
Mailing Address - Street 2:
Mailing Address - City:ELM CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27822-9217
Mailing Address - Country:US
Mailing Address - Phone:252-245-3031
Mailing Address - Fax:252-245-3033
Practice Address - Street 1:416 N PARKER ST
Practice Address - Street 2:
Practice Address - City:ELM CITY
Practice Address - State:NC
Practice Address - Zip Code:27822-9217
Practice Address - Country:US
Practice Address - Phone:252-245-3031
Practice Address - Fax:252-245-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL 098-028310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMC-MEDICAIDMedicaid