Provider Demographics
NPI:1063543882
Name:SHANGRI-LA OF BUNCOMBE INC.
Entity type:Organization
Organization Name:SHANGRI-LA OF BUNCOMBE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:BRINKLEY
Authorized Official - Last Name:PIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-645-2548
Mailing Address - Street 1:113 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-6305
Mailing Address - Country:US
Mailing Address - Phone:828-645-2548
Mailing Address - Fax:828-645-7051
Practice Address - Street 1:113 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-6305
Practice Address - Country:US
Practice Address - Phone:828-645-2548
Practice Address - Fax:828-645-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-011-059311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802161Medicaid