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General NPI Number Information
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NPI Number | 1295723377
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Entity Type | Organization
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Legal Business Name | BAPTIST RETIREMENT HOMES OF NORTH CAROLINA INCORPORATED
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 12/12/2007
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Provider Practice Location Address
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Address Line | 1199 HAYES FOREST DR
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City | WINSTON-SALEM
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State | NC
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Zip | 27106-3377
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Country | US
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Telephone | 336-759-1044
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Fax | 336-759-7389
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Provider Business Mailing Address
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Address Line | PO BOX 11024
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City | WINSTON-SALEM
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State | NC
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Zip | 27116-1024
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Country | US
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Telephone | 336-725-0202
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Fax | 336-725-0449
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM B STILLERMAN
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Credential |
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Telephone | 336-759-1044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | NH0056
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH0056
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License Number State | NC
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