Healthcare Provider Details

I. General information

NPI: 1003891953
Provider Name (Legal Business Name): RANDOLPH HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 WHITE OAK ST
ASHEBORO NC
27203-5434
US

IV. Provider business mailing address

364 WHITE OAK ST
ASHEBORO NC
27203-5434
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-5151
  • Fax: 336-633-7795
Mailing address:
  • Phone: 336-633-7722
  • Fax: 336-625-2209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC0522
License Number StateNC

VIII. Authorized Official

Name: MRS. LORETTA M LONG
Title or Position: CFO
Credential:
Phone: 336-625-5151