Provider Demographics
NPI:1336602358
Name:CITADEL AT MYERS PARK LLC
Entity Type:Organization
Organization Name:CITADEL AT MYERS PARK LLC
Other - Org Name:MYERS PARK NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BATYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORELICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-334-1671
Mailing Address - Street 1:300 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1420
Mailing Address - Country:US
Mailing Address - Phone:704-334-1671
Mailing Address - Fax:
Practice Address - Street 1:300 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1420
Practice Address - Country:US
Practice Address - Phone:704-334-1671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care