Organization
FRONT STREET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LUELLA TATE (OWNER)
(919) 553-1958
Entity
Organization
Contact information
Practice address
204 E RIDGE CIR, CLAYTON, NC 27520-2023
(919) 553-1958
(919) 553-1958
Mailing address
PO BOX 25752, RALEIGH, NC 27611-5752
(919) 553-1958
(919) 553-1958
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
FCL-051-017
NC
Other
Enumeration date
03/29/2007
Last updated
12/07/2012
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