Healthcare Provider Details

I. General information

NPI: 1043314602
Provider Name (Legal Business Name): PPRC NURSING HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 WESTCHESTER DR
HIGH POINT NC
27262-7008
US

IV. Provider business mailing address

1795 WESTCHESTER DR
HIGH POINT NC
27262-7008
US

V. Phone/Fax

Practice location:
  • Phone: 336-888-4567
  • Fax: 336-888-4663
Mailing address:
  • Phone: 336-888-4567
  • Fax: 336-888-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0155
License Number StateNC

VIII. Authorized Official

Name: MS. SHERRY ANN TILLEY
Title or Position: BILLING MANAGER
Credential:
Phone: 336-888-4567