Healthcare Provider Details

I. General information

NPI: 1205986577
Provider Name (Legal Business Name): HILLSIDE NURSING CENTER OF WAKE FOREST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 WAIT AVE
WAKE FOREST NC
27587-7670
US

IV. Provider business mailing address

968 WAIT AVE
WAKE FOREST NC
27587-7670
US

V. Phone/Fax

Practice location:
  • Phone: 919-556-4082
  • Fax: 919-554-4650
Mailing address:
  • Phone: 919-556-4082
  • Fax: 919-554-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0525
License Number StateNC

VIII. Authorized Official

Name: MRS. TONDA C GLENN
Title or Position: OFFICE MANAGER
Credential:
Phone: 919-556-4082