Provider Demographics
NPI:1972643229
Name:ST. MARY'S ASSISTED LIVING OF PLEASANT HILL
Entity type:Organization
Organization Name:ST. MARY'S ASSISTED LIVING OF PLEASANT HILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSLIN
Authorized Official - Middle Name:GARNER
Authorized Official - Last Name:KENNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-536-4919
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27866-0014
Mailing Address - Country:US
Mailing Address - Phone:252-536-4919
Mailing Address - Fax:252-536-3695
Practice Address - Street 1:4427 US HWY 301
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:NC
Practice Address - Zip Code:27866-9687
Practice Address - Country:US
Practice Address - Phone:252-536-4919
Practice Address - Fax:252-536-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL066009310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility