Provider Demographics
NPI:1689886111
Name:SUTTON'S RETIREMENT CENTER
Entity Type:Organization
Organization Name:SUTTON'S RETIREMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:SUTTON
Authorized Official - Last Name:TINGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-759-9695
Mailing Address - Street 1:4258 HWY 13 NORTH
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534
Mailing Address - Country:US
Mailing Address - Phone:919-759-9695
Mailing Address - Fax:
Practice Address - Street 1:4258 HWY 13 NORTH
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534
Practice Address - Country:US
Practice Address - Phone:919-759-9695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL 096029310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805319Medicaid