Provider Demographics
NPI:1811047624
Name:NOATIONS DBA
Entity type:Organization
Organization Name:NOATIONS DBA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-667-2211
Mailing Address - Street 1:PO BOX 1227
Mailing Address - Street 2:206 OLD BRICKYARD RD.
Mailing Address - City:N WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-1227
Mailing Address - Country:US
Mailing Address - Phone:336-667-2211
Mailing Address - Fax:336-667-8199
Practice Address - Street 1:206 OLD BRICKYARD RD.
Practice Address - Street 2:
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-1227
Practice Address - Country:US
Practice Address - Phone:336-667-2211
Practice Address - Fax:336-667-8199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804999Medicaid