Healthcare Provider Details

I. General information

NPI: 1164567715
Provider Name (Legal Business Name): BEATRICE PETWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/30/2023
Certification Date: 09/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 HILL ST
ROCKY MOUNT NC
27801-6002
US

IV. Provider business mailing address

730 MARIGOLD ST
ROCKY MOUNT NC
27801-5908
US

V. Phone/Fax

Practice location:
  • Phone: 252-813-5960
  • Fax: 252-442-1147
Mailing address:
  • Phone: 252-813-5960
  • Fax: 252-442-1147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL033004
License Number StateNC

VIII. Authorized Official

Name: BEATRICE PETWAY
Title or Position: OWNER
Credential:
Phone: 252-813-5960