Healthcare Provider Details

I. General information

NPI: 1902946411
Provider Name (Legal Business Name): BAPTIST CHILDREN'S HOMES OF NORTH CAROLINA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 WATSON AVE
THOMASVILLE NC
27360-4540
US

IV. Provider business mailing address

204 IDOL ST P. O BOX 338
THOMASVILLE NC
27360-4514
US

V. Phone/Fax

Practice location:
  • Phone: 336-474-1200
  • Fax: 336-472-4110
Mailing address:
  • Phone: 336-474-1276
  • Fax: 336-472-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberB00076
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberB00076
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberB00076
License Number StateNC

VIII. Authorized Official

Name: MR. SAMUEL V. BAREFOOT
Title or Position: TREASURER CFO
Credential:
Phone: 336-474-1224