| Organization Name: | CLEMMONS ASSISTED LIVING LLC |
| NPI Number: | 1649355439 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALDO BACCALA (OWNER / MANAGER) |
| Mailing Address: | 6441 Holder Rd Clemmons |
| State: | NC US |
| Postal Code: | 270129207 |
| Phone Number: | 3367788548 |
| Fax Number: | 3367788875 |
| NPI Enumeration Date: | 10/27/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 310400000X |
| License Number: | HAL-034-062 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Assisted Living Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |