Healthcare Provider Details

I. General information

NPI: 1588642102
Provider Name (Legal Business Name): ARCHDALE NURSING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LANE DR
TRINITY NC
27370-9343
US

IV. Provider business mailing address

116 LANE DR
TRINITY NC
27370-9343
US

V. Phone/Fax

Practice location:
  • Phone: 336-431-8888
  • Fax: 336-431-9053
Mailing address:
  • Phone: 336-431-8888
  • Fax: 336-431-9053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0489
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberNH0489
License Number StateNC

VII. Legacy identifiers

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

# 1
Identifier7801536
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier3405330
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: MRS. SARAH BENNETT
Title or Position: CONTROLLER/ASSIST. ADMINISTRATOR
Credential: LNHA
Phone: 336-431-8888