Organization
JACKSONVILLE CARE LLC
Active
Other names
Light House Village
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACQUELINE W PIERCE (MANAGING MEMBER)
(336) 643-0555
Entity
Organization
Contact information
Practice address
182 VILLAGE DR, JACKSONVILLE, NC 28546-7238
(910) 353-7111
(910) 353-2799
Mailing address
PO BOX 878, OAK RIDGE, NC 27310-0878
(336) 643-0555
(336) 643-0553
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
HAL-067-013
NC
311Z00000X
Custodial Care Facility
Primary
HAL-067-013
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804343
—
NC
Enumeration date
03/06/2007
Last updated
11/13/2023
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