Provider Demographics
NPI:1689722944
Name:COVENTRY HOUSE OF ZEBULON
Entity Type:Organization
Organization Name:COVENTRY HOUSE OF ZEBULON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAVONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-269-7762
Mailing Address - Street 1:1225 W GANNON AVE
Mailing Address - Street 2:PO BOX 888
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-8838
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1225 W GANNON AVE
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-8838
Practice Address - Country:US
Practice Address - Phone:919-269-7762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-092-115310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805473OtherPROVIDER NUMBER