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General NPI Number Information
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NPI Number | 1568454262
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Entity Type | Organization
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Legal Business Name | MORAVIAN HOME INCORPORATED
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 11/18/2010
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Provider Practice Location Address
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Address Line | 1000 SALEMTOWNE DR
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City | WINSTON-SALEM
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State | NC
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Zip | 27106-3294
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Country | US
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Telephone | 336-767-8130
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Fax | 336-767-4090
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Provider Business Mailing Address
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Address Line | 1000 SALEMTOWNE DR
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City | WINSTON-SALEM
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State | NC
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Zip | 27106-3294
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Country | US
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Telephone | 336-767-8130
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Fax | 336-767-4090
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Authorized Official
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Title or Position | CFO
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Name | MS. CAROLYN J. TWISDALE
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Credential |
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Telephone | 336-767-8130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH0154
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License Number State | NC
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