Provider Demographics
NPI:1124665245
Name:MOYERS ASSISTED LIVING COMPASSIONATE LLC
Entity type:Organization
Organization Name:MOYERS ASSISTED LIVING COMPASSIONATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:COKY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KERNODLE
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:336-327-9438
Mailing Address - Street 1:5767 NC HIGHWAY 135
Mailing Address - Street 2:
Mailing Address - City:STONEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27048-8477
Mailing Address - Country:US
Mailing Address - Phone:336-445-4004
Mailing Address - Fax:336-445-0148
Practice Address - Street 1:5767 NC HIGHWAY 135
Practice Address - Street 2:
Practice Address - City:STONEVILLE
Practice Address - State:NC
Practice Address - Zip Code:27048-8477
Practice Address - Country:US
Practice Address - Phone:336-445-4004
Practice Address - Fax:336-445-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility