Provider Demographics
NPI:1215972609
Name:HUNTERSVILLE OAKS
Entity type:Organization
Organization Name:HUNTERSVILLE OAKS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:COWDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:704-875-7400
Mailing Address - Street 1:12019 VERHOEFF DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-9217
Mailing Address - Country:US
Mailing Address - Phone:704-875-7400
Mailing Address - Fax:
Practice Address - Street 1:12019 VERHOEFF DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-9217
Practice Address - Country:US
Practice Address - Phone:704-875-7400
Practice Address - Fax:704-874-7490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0377314000000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0469950001OtherMEDICARE DME
NC345096Medicare Oscar/Certification