MEDICARE: FRIENDS HOMES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	NH0554	NC
2	313M00000X	Nursing Facility/Intermediate Care Facility	NH0554	NC
3	314000000X	Skilled Nursing Facility	NH0554	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00833	OTHER	NC	BCBS PROVIDER #

General Provider Information

NPI Number	:	1730183625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIENDS HOMES, INC.

Provider Business Mailing Address
First Line	:	6100 W FRIENDLY AVENUE
Second Line	:	FRIENDS HOMES WEST
City	:	GREENSBORO
State	:	NC
Zip	:	27410
Country	:	US
Telephone Number	:	336-292-9952
Fax Number	:	336-294-0129

Provider Business Practice Location Address
First Line	:	6100 W FRIENDLY AVENUE
Second Line	:	FRIENDS HOMES WEST
City	:	GREENSBORO
State	:	NC
Zip	:	27410
Country	:	US
Telephone Number	:	336-292-9952
Fax Number	:	336-294-0129

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DONNA SPRINKLE
Credential	:
Telephone Number	:	336-292-9952

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	11/06/2014

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Directions to “FRIENDS HOMES, INC. ” Practice Location

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