Mallard Ridge Llc

LBN: Mallard Ridge Llc
Mallard Ridge Llc is an health care organization with primary practice located at 851 Old Winston Rd , Kernersville NC 27284-8780. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Assisted Living Facility, which is considered as the primary health care specialty. Mallard Ridge Llc can be contacted via phone (336) 993-7555, or through Hennessee, Tracy via phone (336) 775-2205.

Contact Information

Primary practice address
851 Old Winston Rd Kernersville NC 27284-8780
Phone: (336) 993-7555
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Hennessee, Tracy
Phone: (336) 775-2205

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Assisted Living Facility 310400000X HAL 029 007 North Carolina

Profile Details

NPI number 1861523896
LBN Legal business name Mallard Ridge Llc
DBA Doing business as
Authorized official Hennessee, Tracy
Entity Organization
Organization subpart 1 No
Enumeration date Mar 9th, 2007
Last updated Aug 22nd, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861523896 NPPES
North Carolina MEDICAID 7805429

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