# WATERSIDE HEALTHCARE INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Waterbrooke Assisted Living
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992843577
- **Authorized official:** MR. DAVID B GOLDSTON III (PRESIDENT)
- **Authorized official phone:** (910) 754-6621

## Contact information

- **Practice address:** 703 ELIZABETH ST, TABOR CITY, NC 28463-2603
- **Practice address phone:** (910) 653-6400
- **Mailing address:** PO BOX 1559, SHALLOTTE, NC 28459-1559
- **Mailing address phone:** (910) 754-6621

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | HAL-024-008 | NC | Yes |

## Other

- **Enumeration date:** 02/03/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7805373 | — | NC |