1750418802 NPI number — ALAMANCE EXTENDED CARE, INC.

Table of content: (NPI 1750418802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750418802 NPI number — ALAMANCE EXTENDED CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAMANCE EXTENDED CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EDGEWOOD PLACE AT THE VILLAGE AT BROOKWOOD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750418802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 BROOKWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27215-3200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-570-8456
Provider Business Mailing Address Fax Number:
336-570-8460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1860 BROOKWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27215-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-570-8456
Provider Business Practice Location Address Fax Number:
336-570-8460
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BENTON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
336-570-8458

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  NH0596 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0015735 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39746 . This is a "PARTNERS MEDICARE CHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7805329 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00826 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3416590 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3415091 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100024 . This is a "UNITED HEALTHCARE MEDICAR" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com