Provider Demographics
NPI:1801230545
Name:NIC 4 COURTYARDS OF NEW BERN LEASING LLC
Entity Type:Organization
Organization Name:NIC 4 COURTYARDS OF NEW BERN LEASING LLC
Other - Org Name:THE COURTYARDS AT BERNE VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FALKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-304-5029
Mailing Address - Street 1:2901 DALLAS PKWY
Mailing Address - Street 2:SUITE 380
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5980
Mailing Address - Country:US
Mailing Address - Phone:469-304-5029
Mailing Address - Fax:
Practice Address - Street 1:2901 DALLAS PKWY
Practice Address - Street 2:SUITE 380
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5980
Practice Address - Country:US
Practice Address - Phone:469-304-5029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL025024310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805631Medicaid