Provider Demographics
NPI:1609603687
Name:ENSPIRE RESIDENTIAL LIVING CO.
Entity type:Organization
Organization Name:ENSPIRE RESIDENTIAL LIVING CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLOCK-BLOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:252-347-5209
Mailing Address - Street 1:5215 STANTONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7075
Mailing Address - Country:US
Mailing Address - Phone:252-481-2282
Mailing Address - Fax:
Practice Address - Street 1:500 CONTENTNEA ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3122
Practice Address - Country:US
Practice Address - Phone:252-481-2822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care