Provider Demographics
NPI:1386141851
Name:NARU LEGACY INCORPORATED
Entity type:Organization
Organization Name:NARU LEGACY INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALEBOGO
Authorized Official - Middle Name:NANZALA
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:336-392-1953
Mailing Address - Street 1:7707 TALL MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-6706
Mailing Address - Country:US
Mailing Address - Phone:336-392-1953
Mailing Address - Fax:
Practice Address - Street 1:4266 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-2510
Practice Address - Country:US
Practice Address - Phone:336-392-1953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility