1932209988 NPI number — KRRAM-Z,LLC

Table of content: (NPI 1932209988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932209988 NPI number — KRRAM-Z,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KRRAM-Z,LLC
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:
MAPLE HEIGHTS REST HOME
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:
1932209988
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:
2251 SALLIES LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27106-8613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-922-5162
Provider Business Mailing Address Fax Number:
336-922-2074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2065 CHUB LAKE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROXBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-599-1255
Provider Business Practice Location Address Fax Number:
336-599-1850
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAMSEY
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
336-922-5162

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  7804688 , 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: 7804688 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com