Provider Demographics
NPI:1730322348
Name:YADKIN SENIOR SERVICES, INC.
Entity Type:Organization
Organization Name:YADKIN SENIOR SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:RUMMAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-679-2740
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-0789
Mailing Address - Country:US
Mailing Address - Phone:336-679-2740
Mailing Address - Fax:336-679-2449
Practice Address - Street 1:108-B EAST ELM STREET
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-8203
Practice Address - Country:US
Practice Address - Phone:336-679-3740
Practice Address - Fax:336-679-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408547Medicaid
NC6600472Medicaid