Healthcare Provider Details

I. General information

NPI: 1386416147
Provider Name (Legal Business Name): BLAIR STREET OPERATING COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 BLAIR ST
THOMASVILLE NC
27360-4359
US

IV. Provider business mailing address

1028 BLAIR ST
THOMASVILLE NC
27360-4359
US

V. Phone/Fax

Practice location:
  • Phone: 336-472-7771
  • Fax:
Mailing address:
  • Phone: 336-472-7771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: YOSEF EMANUEL
Title or Position: MEMBER
Credential:
Phone: 917-745-7945