Provider Demographics
NPI:1700807989
Name:SPRING ARBOR OF RALEIGH
Entity Type:Organization
Organization Name:SPRING ARBOR OF RALEIGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-250-0255
Mailing Address - Street 1:1810 N NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-8305
Mailing Address - Country:US
Mailing Address - Phone:919-250-0255
Mailing Address - Fax:919-250-0247
Practice Address - Street 1:1810 N NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-8305
Practice Address - Country:US
Practice Address - Phone:919-250-0255
Practice Address - Fax:919-250-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-092-079310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804244Medicaid