Provider Demographics
NPI:1699970988
Name:DANNY TUTTLE, INC.
Entity type:Organization
Organization Name:DANNY TUTTLE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-853-7670
Mailing Address - Street 1:1025 LAMB RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-5229
Mailing Address - Country:US
Mailing Address - Phone:336-853-7670
Mailing Address - Fax:336-853-7671
Practice Address - Street 1:1135 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NC
Practice Address - Zip Code:27053-7437
Practice Address - Country:US
Practice Address - Phone:336-994-2120
Practice Address - Fax:336-994-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-085-003310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801516Medicaid