Organization
PIEDMONT VILLAGE AT STATESVILLE, INC.
Active
Other names
Piedmont Village at Statesville
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL WALCZAK (CEO)
(561) 627-0664
Entity
Organization
Contact information
Practice address
1902 ORA DR, STATESVILLE, NC 28625-6343
(704) 878-6376
(704) 878-6787
Mailing address
2979 PGA BLVD, PALM BEACH GARDENS, FL 33410-2911
(561) 627-0664
(561) 627-2867
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
HAL-049-014
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7803560
—
NC
Enumeration date
07/21/2006
Last updated
08/22/2020
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