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General NPI Number Information
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NPI Number | 1912172198
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Entity Type | Organization
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Legal Business Name | HINES GOOD SAMARITAN HOME
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 2317 ELBON DR
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City | WINSTON SALEM
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State | NC
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Zip | 27105-5649
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Country | US
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Telephone | 336-722-7818
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Fax |
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Provider Business Mailing Address
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Address Line | 2224 MANCHESTER ST
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City | WINSTON SALEM
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State | NC
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Zip | 27105-5536
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Country | US
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Telephone | 336-727-1308
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Fax | 336-723-8142
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARGARETTA HINES MOORE
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Credential |
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Telephone | 336-727-1308
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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 | FCL034077
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License Number State | NC
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