Provider Demographics
NPI:1831908441
Name:JAYBIRD LSE PV05 LLC
Entity type:Organization
Organization Name:JAYBIRD LSE PV05 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-242-6369
Mailing Address - Street 1:5383 US HIGHWAY 117 N
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27863-9443
Mailing Address - Country:US
Mailing Address - Phone:919-242-6369
Mailing Address - Fax:919-242-6370
Practice Address - Street 1:5383 US HIGHWAY 117 N
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:NC
Practice Address - Zip Code:27863-9443
Practice Address - Country:US
Practice Address - Phone:919-242-6369
Practice Address - Fax:919-242-6370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility