Organization
CEMMONS VILLAGE I, LLC
Active
Other names
Clemmons Village I
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC HADLEY (COO)
(843) 296-3985
Entity
Organization
Contact information
Practice address
6401 HOLDER RD, CLEMMONS, NC 27012-9207
(336) 766-2990
(336) 766-2138
Mailing address
6401 HOLDER RD, CLEMMONS, NC 27012-9207
(336) 766-2990
(336) 766-2138
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
HAL-034-090
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805214
—
NC
Enumeration date
09/27/2006
Last updated
06/21/2010
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