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STATESVILLE ASSISTED LIVING
NPI 1124191804
Preferred Provider Organization in Statesville, NC

Active since November 17, 2006
2147 DAVIE AVE, STATESVILLE, NC 28625(704) 878-0123(704) 878-8689 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Statesville Assisted Living NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STATESVILLE ASSISTED LIVING (NPI 1124191804) is a healthcare organization registered as a preferred provider organization in Statesville, North Carolina and active in the NPI registry since November 2006. The organization lists Aldo Baccala, Execuitve Officer, as its authorized official.

NPPES Registry Identity

NPI1124191804
Entity TypeOrganization
Primary Taxonomy305R00000X
Legal Business NameSTATESVILLE ASSISTED LIVING
Location Address2147 DAVIE AVEStatesville, NC 28625-9200
Mailing Address2147 Davie AveStatesville, NC 28625-9200 · (704) 878-0123 · Fax (704) 878-8689
Phone(704) 878-0123
Fax(704) 878-8689
Organization SubpartNo
Authorized OfficialAldo BaccalaExecuitve Officer · (707) 778-6719
Enumeration DateNovember 17, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1124191804 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPreferred Provider OrganizationManaged Care Organizations
Taxonomy Code305R00000X
License✔ Licensed in NC · HAL-049-023
Definition
A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.
2147 DAVIE AVE, Statesville, NC 28625
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Other Identifiers 1

Medicaid7804765NC

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. MELISSA GOTTHEIM WILDT OT
Occupational Therapist
2147 DAVIE AVE, GARDENS OF STATESVILLE
STATESVILLE, NC 28625
Iredell County (704) 878-8689
COMPREHENSIVE THERAPEUTICS LTD
Physical Therapist
2147 DAVIE AVE
STATESVILLE, NC 28625
Iredell County (704) 994-8093
STATESVILLE ASSISTED LIVING, LLC
Assisted Living Facility
2147 DAVIE AVE
STATESVILLE, NC 28625
Iredell County (704) 878-0123

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Statesville Assisted Living's NPI number?

The NPI number for Statesville Assisted Living is 1124191804. It was assigned to this organization in the NPPES registry on November 17, 2006.

Where is Statesville Assisted Living located?

Statesville Assisted Living is located at 2147 Davie Ave, Statesville, NC 28625. The listed phone number is (704) 878-0123.

What is Statesville Assisted Living's specialty?

The primary specialty registered for this NPI is Preferred Provider Organization with taxonomy code 305R00000X.

When was this NPI record last updated?

The NPPES record for Statesville Assisted Living was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.