Organization
EDENTON RETIREMENT COMMUNITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID DEAN WILSON (MANAGING PARTNER)
(336) 495-2700
Entity
Organization
Contact information
Practice address
106 MARK DR, EDENTON, NC 27932-1756
(252) 482-4491
Mailing address
PO BOX 814, RANDLEMAN, NC 27317-0814
(336) 495-2700
(336) 495-5552
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
311ZA0620X
Adult Care Home Facility
HAL-021-008
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7806302
—
NC
Enumeration date
04/08/2010
Last updated
06/13/2013
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