Provider Demographics
NPI:1932481249
Name:BYPETERSON PROPERTIES, LLC
Entity Type:Organization
Organization Name:BYPETERSON PROPERTIES, LLC
Other - Org Name:BROOKSTONE TERRACE ASSISTED LIVING FACILTIY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-502-3210
Mailing Address - Street 1:4430 CLINARD RD
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8487
Mailing Address - Country:US
Mailing Address - Phone:336-766-5000
Mailing Address - Fax:336-766-5020
Practice Address - Street 1:4430 CLINARD RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8487
Practice Address - Country:US
Practice Address - Phone:336-766-5000
Practice Address - Fax:336-766-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC310400000X, 311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)