Provider Demographics
NPI:1952045148
Name:MORGANTON GERIATRIC LLC
Entity Type:Organization
Organization Name:MORGANTON GERIATRIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHANI
Authorized Official - Middle Name:MOHAN
Authorized Official - Last Name:VUPADHYAYULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-989-5736
Mailing Address - Street 1:1121 BALTUSROL LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-9031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 CAMELLIA GARDEN ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-8207
Practice Address - Country:US
Practice Address - Phone:828-433-5875
Practice Address - Fax:828-433-7022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home