Provider Demographics
NPI:1861510992
Name:UNIVERSAL HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:UNIVERSAL HEALTHCARE SERVICES
Other - Org Name:DOGWOOD FOREST - NICOLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FIAGER
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-694-7785
Mailing Address - Street 1:PO BOX 2828
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-2828
Mailing Address - Country:US
Mailing Address - Phone:336-229-6866
Mailing Address - Fax:336-229-6003
Practice Address - Street 1:858 ROSS ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-1651
Practice Address - Country:US
Practice Address - Phone:336-229-6866
Practice Address - Fax:336-229-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-001-005310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility