Provider Demographics
NPI:1316092505
Name:NORTHSTAR SENIOR LIVING
Entity type:Organization
Organization Name:NORTHSTAR SENIOR LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:UHLIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-242-8300
Mailing Address - Street 1:2334 WASHINGTON AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-242-8300
Mailing Address - Fax:530-222-6725
Practice Address - Street 1:2744 SOUTH 17TH ST.
Practice Address - Street 2:PACIFICA WILMINGTON
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412
Practice Address - Country:US
Practice Address - Phone:910-452-1114
Practice Address - Fax:530-222-6725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL 065024310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
7804165Medicare PIN