Provider Demographics
NPI:1790716561
Name:SPRING ARBOR OF KINSTON, LTD
Entity Type:Organization
Organization Name:SPRING ARBOR OF KINSTON, LTD
Other - Org Name:SPRING ARBOR OF KINSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-3099
Mailing Address - Street 1:3207 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-1205
Mailing Address - Country:US
Mailing Address - Phone:252-523-3099
Mailing Address - Fax:252-523-1020
Practice Address - Street 1:3207 CAREY RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-1205
Practice Address - Country:US
Practice Address - Phone:252-523-3099
Practice Address - Fax:252-523-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-054-006310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803509Medicaid