Provider Demographics
NPI:1689799223
Name:STARMONT ASSISTED LIVING
Entity Type:Organization
Organization Name:STARMONT ASSISTED LIVING
Other - Org Name:STARMONT ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-428-2101
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:NC
Mailing Address - Zip Code:27356-0157
Mailing Address - Country:US
Mailing Address - Phone:910-428-2101
Mailing Address - Fax:910-428-1131
Practice Address - Street 1:327 FREEMAN STREET
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:NC
Practice Address - Zip Code:27356-0157
Practice Address - Country:US
Practice Address - Phone:910-428-2101
Practice Address - Fax:910-428-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-062-012310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805599Medicaid