Organization
CREEKSIDE ASSISTED LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RILEY S EVANS (MANAGING MEMBER)
(910) 648-6887
Entity
Organization
Contact information
Practice address
1124 CEDAR CREEK RD, FAYETTEVILLE, NC 28312-6544
(910) 323-8212
(910) 323-2159
Mailing address
PO BOX 847, CLARKTON, NC 28433-0847
(910) 648-6887
(910) 648-6888
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
HAL-026-059
NC
Other
Enumeration date
10/05/2011
Last updated
10/05/2011
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