Organization
SER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARICKEYO SENTWAN HUSKEY (ADMINISTRATOR)
(704) 600-6710
Entity
Organization
Contact information
Practice address
208 LESLIE DR, SHELBY, NC 28152-0758
(704) 600-6480
(704) 600-6480
Mailing address
208 LESLIE DR, SHELBY, NC 28152-0758
(704) 600-6480
(704) 600-6480
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
NC
Other
Enumeration date
07/10/2012
Last updated
07/10/2012
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