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General NPI Number Information
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NPI Number | 1225224173
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Entity Type | Organization
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Legal Business Name | PINEHURST NURSING CENTER, INC.
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 300 BLAKE BLVD
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City | PINEHURST
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State | NC
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Zip | 28374-8474
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Country | US
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Telephone | 910-295-6158
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Fax | 910-295-6783
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Provider Business Mailing Address
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Address Line | PO BOX 5309
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City | PINEHURST
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State | NC
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Zip | 28374-5309
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Country | US
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Telephone | 910-295-6158
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Fax | 910-295-6783
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. NICK W ELLEDGE
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Credential |
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Telephone | 336-679-8852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | NH0294
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License Number State | NC
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