Provider Demographics
NPI:1992849467
Name:SHARPER IMAGES OF FAYETTEVILLE, INC
Entity Type:Organization
Organization Name:SHARPER IMAGES OF FAYETTEVILLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-574-4716
Mailing Address - Street 1:PO BOX 9005
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9079
Mailing Address - Country:US
Mailing Address - Phone:910-484-1684
Mailing Address - Fax:
Practice Address - Street 1:303 WOODBERRY CIR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-9181
Practice Address - Country:US
Practice Address - Phone:910-875-3146
Practice Address - Fax:910-484-1684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-047-0863104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness