Provider Demographics
NPI:1851458616
Name:HARRIS ENTERPRISE OF NC, INC.
Entity Type:Organization
Organization Name:HARRIS ENTERPRISE OF NC, INC.
Other - Org Name:WALDEN POND CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORMSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-460-7072
Mailing Address - Street 1:PO BOX 1803
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28151-1803
Mailing Address - Country:US
Mailing Address - Phone:704-460-7072
Mailing Address - Fax:704-484-3098
Practice Address - Street 1:101 OLD COACH LN
Practice Address - Street 2:
Practice Address - City:CROUSE
Practice Address - State:NC
Practice Address - Zip Code:28033-9735
Practice Address - Country:US
Practice Address - Phone:704-460-7072
Practice Address - Fax:704-484-3098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCSCL-036-025310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility