Provider Demographics
NPI:1952057424
Name:RSS/KERNERSVILLE II OPERATIONS, LLC
Entity Type:Organization
Organization Name:RSS/KERNERSVILLE II OPERATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WIERZBICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-371-4233
Mailing Address - Street 1:5430 WADE PARK BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-4191
Mailing Address - Country:US
Mailing Address - Phone:919-371-4233
Mailing Address - Fax:
Practice Address - Street 1:250 HOPKINS RD
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-9314
Practice Address - Country:US
Practice Address - Phone:336-901-9080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility