Provider Demographics
NPI:1205171154
Name:CLINTON HEALTH HOLDINGS LLC
Entity type:Organization
Organization Name:CLINTON HEALTH HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:REEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-763-6300
Mailing Address - Street 1:2015 AYRSLEY TOWN BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4068
Mailing Address - Country:US
Mailing Address - Phone:704-280-8340
Mailing Address - Fax:704-973-4019
Practice Address - Street 1:205 MARTHA LN
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-9639
Practice Address - Country:US
Practice Address - Phone:910-592-0154
Practice Address - Fax:910-592-6361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-082-018310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility