Provider Demographics
NPI:1841557543
Name:VANDERBILL CHERRY, JR
Entity type:Organization
Organization Name:VANDERBILL CHERRY, JR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VANDERBILL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:252-325-2977
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:AULANDER
Mailing Address - State:NC
Mailing Address - Zip Code:27805-0789
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:743 CHARLES TAYLOR RD
Practice Address - Street 2:
Practice Address - City:AULANDER
Practice Address - State:NC
Practice Address - Zip Code:27805-9690
Practice Address - Country:US
Practice Address - Phone:252-325-2977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VANDERBILL CHERRY JR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-18
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL008030310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility