Organization
CLEMMONS ASSISTED LIVING LLC
Active
Other names
Clemmons Village II
Organization subpart
No
Provider details
NPI number
Authorized official
ALDO BACCALA (OWNER / MANAGER)
(707) 778-6713
Entity
Organization
Contact information
Practice address
6441 HOLDER RD, CLEMMONS, NC 27012-9207
(336) 778-8548
(336) 778-8875
Mailing address
6441 HOLDER RD, CLEMMONS, NC 27012-9207
(336) 778-8548
(336) 778-8875
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
HAL-034-062
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804691
—
NC
Enumeration date
10/27/2006
Last updated
08/22/2020
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