Provider Demographics
NPI:1427872027
Name:A VISION COME TRUE ASSISTANT LIVING FACILITY LLC
Entity type:Organization
Organization Name:A VISION COME TRUE ASSISTANT LIVING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-670-5700
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-0035
Mailing Address - Country:US
Mailing Address - Phone:910-670-5700
Mailing Address - Fax:
Practice Address - Street 1:220 HATCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2318
Practice Address - Country:US
Practice Address - Phone:336-550-9999
Practice Address - Fax:336-550-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility