1972587376 NPI number — THE UNITED METHODIST RETIREMENT HOMES, INCORPORATED

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972587376 NPI number — THE UNITED METHODIST RETIREMENT HOMES, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE UNITED METHODIST RETIREMENT HOMES, INCORPORATED
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:
CROASDAILE VILLAGE
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:
1972587376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 CROASDAILE FARM PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27705-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-384-2000
Provider Business Mailing Address Fax Number:
919-384-2480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 CROASDAILE FARM PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27705-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-384-2000
Provider Business Practice Location Address Fax Number:
919-384-2480
Provider Enumeration Date:
11/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ERICKSON
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
919-384-3001

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  NH0587 , 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: 3405501 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 340612Y , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00880 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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