Provider Demographics
NPI:1265585699
Name:HAPPY VALLEY RETIREMENT CENTER
Entity type:Organization
Organization Name:HAPPY VALLEY RETIREMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:T
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-425-6966
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-0277
Mailing Address - Country:US
Mailing Address - Phone:910-425-6530
Mailing Address - Fax:910-425-4537
Practice Address - Street 1:4124 PECAN DR
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-2423
Practice Address - Country:US
Practice Address - Phone:910-425-6530
Practice Address - Fax:910-425-4537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-026-004310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility