Provider Demographics
NPI:1952986044
Name:PS SENIOR LIVING OF MOCKSVILLE LLC
Entity Type:Organization
Organization Name:PS SENIOR LIVING OF MOCKSVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRABHJOT
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:269-329-8187
Mailing Address - Street 1:PO BOX 1189
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-1189
Mailing Address - Country:US
Mailing Address - Phone:269-329-8187
Mailing Address - Fax:
Practice Address - Street 1:191 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2643
Practice Address - Country:US
Practice Address - Phone:269-329-8187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home