Provider Demographics
NPI:1710397427
Name:B & B ASSISTED LIVING #5
Entity Type:Organization
Organization Name:B & B ASSISTED LIVING #5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-827-9270
Mailing Address - Street 1:2133 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-8697
Mailing Address - Country:US
Mailing Address - Phone:910-521-7335
Mailing Address - Fax:
Practice Address - Street 1:2133 PRESTON RD
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-8697
Practice Address - Country:US
Practice Address - Phone:910-521-7335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-078-096311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home