Healthcare Provider Details

I. General information

NPI: 1699706606
Provider Name (Legal Business Name): WARREN HILLS, A PERSONAL CARE AND NURSING FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 US HWY. 158 BUSINESS WEST
WARRENTON NC
27589
US

IV. Provider business mailing address

PO BOX 618
WARRENTON NC
27589-0618
US

V. Phone/Fax

Practice location:
  • Phone: 252-257-2011
  • Fax: 252-257-5164
Mailing address:
  • Phone: 252-257-2011
  • Fax: 252-257-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberNH0360
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0360
License Number StateNC

VIII. Authorized Official

Name: MR. DANNY M MOSS
Title or Position: ADMINISTRATOR
Credential:
Phone: 252-257-2011