Organization
CCJ ADULT CARE IV LLC
Active
Other names
Walden Pond Care Home
Organization subpart
No
Provider details
NPI number
Authorized official
BERNICE R HOSCH (ADMINISTRATOR/OPERATOR)
(980) 295-3020
Entity
Organization
Contact information
Practice address
101 OLDE COACH LANE, CHERRYVILLE, NC 28021
(980) 295-3020
Mailing address
PO BOX 74, BESSEMER CITY, NC 28016-0074
(980) 295-3020
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FCL-036-035
STATE OF NORTH CAROLINA
—
Enumeration date
08/23/2021
Last updated
08/24/2021
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