Provider Demographics
NPI:1457413437
Name:PEACE LILY DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:PEACE LILY DEVELOPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-386-8074
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-0705
Mailing Address - Country:US
Mailing Address - Phone:336-386-8074
Mailing Address - Fax:336-386-8394
Practice Address - Street 1:101 PEACE LILLY LN
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8483
Practice Address - Country:US
Practice Address - Phone:336-386-8074
Practice Address - Fax:336-386-8394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL086032315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803740Medicaid