1699706606 NPI number — WARREN HILLS, A PERSONAL CARE AND NURSING FACILITY

Table of content: (NPI 1699706606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699706606 NPI number — WARREN HILLS, A PERSONAL CARE AND NURSING FACILITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WARREN HILLS, A PERSONAL CARE AND NURSING FACILITY
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:
Provider Other Organization Name Type Code:
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:
1699706606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 618
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARRENTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27589-0618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-257-2011
Provider Business Mailing Address Fax Number:
252-257-5164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
864 US HWY. 158 BUSINESS WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-257-2011
Provider Business Practice Location Address Fax Number:
252-257-5164
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOSS
Authorized Official First Name:
DANNY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
252-257-2011

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  NH0360 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: NH0360 , 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: 3406293 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00974 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7801103 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3405240 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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