Provider Demographics
NPI:1811141104
Name:TWENTY TWO PACK MANAGEMENT CORP
Entity type:Organization
Organization Name:TWENTY TWO PACK MANAGEMENT CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-782-1100
Mailing Address - Street 1:1501 ZION CHURCH RD E
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-6827
Mailing Address - Country:US
Mailing Address - Phone:704-782-1100
Mailing Address - Fax:704-721-3144
Practice Address - Street 1:1501 ZION CHURCH RD E
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-6827
Practice Address - Country:US
Practice Address - Phone:704-782-1100
Practice Address - Fax:704-721-3144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility