Organization
VINTAGE INN RETIREMENT COMMUNITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID DEAN WILSON (MANAGING PARTNER)
33649527200
Entity
Organization
Contact information
Practice address
826 EAST BLVD, WILLIAMSTON, NC 27892-2785
(252) 792-8311
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-058-010
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7806303
—
NC
Enumeration date
04/08/2010
Last updated
06/13/2013
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