=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699957183
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAPTIST CHILDREN'S HOMES OF NC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2007
-----------------------------------------------------
Last Update Date | 07/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1380 OLD COX RD
-----------------------------------------------------
City | ASHEBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27205-9466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-626-7002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | BAPTIST CHILDREN'S HOMES OF NC, INC. PO BOX 338
-----------------------------------------------------
City | THOMASVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27361-0338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-474-1272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR DEVELOPMENTAL DISABILITIES
-----------------------------------------------------
Name | MS. F. JANE MCMILLAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-474-1272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | MHL-076-087
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------