# TILLERY'S PLACE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386010908
- **Authorized official:** MISS SHAVONNIE DEANS (OWNER)
- **Authorized official phone:** (252) 446-6613

## Contact information

- **Practice address:** 200 S TILLERY ST, ROCKY MOUNT, NC 27804-5527
- **Practice address phone:** (252) 446-6613
- **Mailing address:** 200 S TILLERY ST, ROCKY MOUNT, NC 27804-5527

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | FCL-064-030 | NC | Yes |

## Other

- **Enumeration date:** 08/18/2015
- **Last updated:** 08/18/2015