Organization
WHITAKER GLEN, INC.
Active
Other names
The Oaks at Whitaker Glen - Mayview
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NEIL L. PRUITT JR. (CHAIRMAN AND CEO)
(770) 279-6200
Entity
Organization
Contact information
Practice address
513 E WHITAKER MILL ROAD, RALEIGH, NC 27608-2699
(919) 828-2348
(919) 828-7554
Mailing address
1626 JEURGENS CT, NORCROSS, GA 30093-2219
(770) 279-6200
(770) 931-5278
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0007
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00876
BCBSNC
—
05
—
3415009
—
NC
05
—
3416061
—
NC
Enumeration date
11/01/2006
Last updated
11/18/2014
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