Healthcare Provider Details

I. General information

NPI: 1770971020
Provider Name (Legal Business Name): BJR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 W. BUNCOMBE ST
ROPER NC
27970-0340
US

IV. Provider business mailing address

206B MALLOY ST
GOLDSBORO NC
27534-4477
US

V. Phone/Fax

Practice location:
  • Phone: 252-791-0002
  • Fax: 252-791-0772
Mailing address:
  • Phone: 919-778-6974
  • Fax: 919-778-6997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberHAL-094-006
License Number StateNC

VIII. Authorized Official

Name: ROY EXCELL MARKHAM
Title or Position: PRESIDENT
Credential:
Phone: 919-778-6974