Provider Demographics
NPI:1215130851
Name:ABBOTT, BOBBY DEAN (ADMINISTRATOR)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:DEAN
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:ADMINISTRATOR
Other - Prefix:MRS
Other - First Name:CRYSTAL
Other - Middle Name:PHELPS
Other - Last Name:ABBOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OWNER
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-0178
Mailing Address - Country:US
Mailing Address - Phone:828-352-9526
Mailing Address - Fax:
Practice Address - Street 1:415 7TH ST SW
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-2414
Practice Address - Country:US
Practice Address - Phone:828-632-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
177F00000X
NC002-006310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No177F00000XOther Service ProvidersLodging