Healthcare Provider Details

I. General information

NPI: 1386845303
Provider Name (Legal Business Name): BAPTIST RETIREMENT HOMES OF NORTH CAROLINA, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NORTH RAILROAD STREET
HAMILTON NC
27840
US

IV. Provider business mailing address

PO BOX 11024
WINSTON SALEM NC
27116-1024
US

V. Phone/Fax

Practice location:
  • Phone: 252-798-5901
  • Fax: 252-798-2209
Mailing address:
  • Phone: 336-725-0300
  • Fax: 336-725-0449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHAL-058-001
License Number StateNC

VIII. Authorized Official

Name: MR. WILLIAM B STILLERMAN
Title or Position: PRESIDENT
Credential:
Phone: 336-759-1044