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General NPI Number Information
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NPI Number | 1548230188
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Entity Type | Organization
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Legal Business Name | MASONIC AND EASTERN STAR HOME OF NORTH CAROLINA, INCORPORATED
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 700 S HOLDEN RD
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City | GREENSBORO
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State | NC
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Zip | 27407-2321
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Country | US
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Telephone | 336-299-0031
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Fax | 336-547-2999
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Provider Business Mailing Address
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Address Line | 700 S HOLDEN RD
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City | GREENSBORO
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State | NC
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Zip | 27407-2321
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Country | US
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Telephone | 336-299-0031
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Fax | 336-547-2999
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Authorized Official
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Title or Position | CHAIRMAN, BOARD OF DIRECTORS
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Name | MR. EUGENE JERNIGAN
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Credential |
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Telephone | 336-299-0031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | NH0141
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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 | NH0141
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License Number State | NC
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