Provider Demographics
NPI:1528353133
Name:M&T ENHANCEMENT RESIDENTIAL CARE, LLC
Entity type:Organization
Organization Name:M&T ENHANCEMENT RESIDENTIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHEAUX
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-884-8889
Mailing Address - Street 1:126 DAVENPORT DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5425
Mailing Address - Country:US
Mailing Address - Phone:910-848-2286
Mailing Address - Fax:910-875-8842
Practice Address - Street 1:126 DAVENPORT DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5425
Practice Address - Country:US
Practice Address - Phone:910-848-2286
Practice Address - Fax:910-875-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC047-139310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility