Healthcare Provider Details

I. General information

NPI: 1083779383
Provider Name (Legal Business Name): NCAL - ROCKY MOUNT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 WESTWOOD DR
ROCKY MOUNT NC
27803-2532
US

IV. Provider business mailing address

1105 BROOKSTOWN AVE
WINSTON SALEM NC
27101-2524
US

V. Phone/Fax

Practice location:
  • Phone: 252-443-5592
  • Fax: 252-446-6969
Mailing address:
  • Phone: 336-724-1000
  • Fax: 336-724-9955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHAL-064-010
License Number StateNC

VIII. Authorized Official

Name: WILLIAM BENTON
Title or Position: CEO
Credential:
Phone: 336-724-1000