1992835847 NPI number — ROSE HILL FAMILY CARE HOME

Table of content: (NPI 1992835847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992835847 NPI number — ROSE HILL FAMILY CARE HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSE HILL FAMILY CARE HOME
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:
1992835847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 BROADWAY ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENOIR
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28645-5005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-754-2504
Provider Business Mailing Address Fax Number:
828-757-3760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 BROADWAY ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28645-5005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-754-2504
Provider Business Practice Location Address Fax Number:
828-757-3760
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOOKER
Authorized Official First Name:
KATIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER OPERATOR
Authorized Official Telephone Number:
828-754-2504

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  FCL014004 , 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: 7802362 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com