Provider Demographics
NPI:1932246303
Name:JACK E. MORGAN
Entity Type:Organization
Organization Name:JACK E. MORGAN
Other - Org Name:DBA CHINA GROVE RETIREMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:704-857-1681
Mailing Address - Street 1:1120 CHINA GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023-6613
Mailing Address - Country:US
Mailing Address - Phone:704-857-1681
Mailing Address - Fax:
Practice Address - Street 1:1114 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHINA GROVE
Practice Address - State:NC
Practice Address - Zip Code:28023-2338
Practice Address - Country:US
Practice Address - Phone:704-255-9780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-080-020310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility