Provider Demographics
NPI:1902391915
Name:COMMON GROUND LIVING LLC
Entity Type:Organization
Organization Name:COMMON GROUND LIVING LLC
Other - Org Name:COMMON GROUND AT RIVERKNOLL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:919-696-1772
Mailing Address - Street 1:201 PARK AT NORTH HILLS APT 410
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:919-696-1772
Mailing Address - Fax:
Practice Address - Street 1:1616 RIVERKNOLL DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-4580
Practice Address - Country:US
Practice Address - Phone:919-696-1772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7806157311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home