Healthcare Provider Details

I. General information

NPI: 1699946616
Provider Name (Legal Business Name): SAINT PAUL RESIDENTIAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 OLD US HIGHWAY 64
SPRING HOPE NC
27882-7517
US

IV. Provider business mailing address

2165 OLD US HIGHWAY 64
SPRING HOPE NC
27882-7517
US

V. Phone/Fax

Practice location:
  • Phone: 252-478-3958
  • Fax:
Mailing address:
  • Phone: 252-478-3958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL035020
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. GERALDINE HARRIS- HOLLOWAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 252-478-3958