Organization
LUBY-JAY INC
Active
Other names
South Haven Long Term Care
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY GAUSE (ADMINISTRATOR)
(704) 830-1101
Entity
Organization
Contact information
Practice address
916 S MARIETTA ST, GASTONIA, NC 28054-5405
(704) 830-1101
Mailing address
PO BOX 1678, CLEMMONS, NC 27012-1678
(336) 998-5001
(336) 998-5470
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
HAL-036-005
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7801358
—
NC
Enumeration date
03/26/2007
Last updated
08/22/2020
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