Organization
STATESVILLE ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALDO BACCALA (EXECUITVE OFFICER)
(707) 778-6719
Entity
Organization
Contact information
Practice address
2147 DAVIE AVE, STATESVILLE, NC 28625-9200
(704) 878-0123
(704) 878-8689
Mailing address
2147 DAVIE AVE, STATESVILLE, NC 28625-9200
(704) 878-0123
(704) 878-8689
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
HAL-049-023
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804765
—
NC
Enumeration date
11/17/2006
Last updated
08/22/2020
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