Provider Demographics
NPI:1710265301
Name:SPRING VALLEY LIVING LLC
Entity Type:Organization
Organization Name:SPRING VALLEY LIVING LLC
Other - Org Name:JUA VALLEY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KANISHA
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:DICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-225-0167
Mailing Address - Street 1:2141 EAST GEER ST ( DURHAM)
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704
Mailing Address - Country:US
Mailing Address - Phone:866-654-1113
Mailing Address - Fax:919-439-0222
Practice Address - Street 1:2141 EAST GEER ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704
Practice Address - Country:US
Practice Address - Phone:866-654-1113
Practice Address - Fax:919-439-0222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRING VALLEY LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-29
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-032-110311ZA0620X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385H00000XRespite Care FacilityRespite Care