Healthcare Provider Details

I. General information

NPI: 1942320759
Provider Name (Legal Business Name): BEAR CREEK MANOR II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 BEAR CREEK RD
BAKERSVILLE NC
28705-8509
US

IV. Provider business mailing address

1501 BEAR CREEK RD
BAKERSVILLE NC
28705-8509
US

V. Phone/Fax

Practice location:
  • Phone: 828-688-3807
  • Fax: 828-688-9407
Mailing address:
  • Phone: 828-688-3807
  • Fax: 828-688-9407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL-061-002
License Number StateNC

VIII. Authorized Official

Name: CHARLES TROY BURKE
Title or Position: ADMINISTRATOR
Credential:
Phone: 828-688-3807