MEDICARE: BUTTRY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	HAL-007-005	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134349822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUTTRY INC.

Provider Business Mailing Address
First Line	:	514 BAY LAKE DR.
Second Line	:
City	:	CHOCOWINITY
State	:	NC
Zip	:	27817-9094
Country	:	US
Telephone Number	:	252-945-8792
Fax Number	:	252-946-5900

Provider Business Practice Location Address
First Line	:	609 W 2ND ST
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-4806
Country	:	US
Telephone Number	:	252-945-8792
Fax Number	:	252-946-5900

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RONALD T. BUTTRY
Credential	:
Telephone Number	:	252-945-8792

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	08/22/2020

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Directions to “BUTTRY INC. ” Practice Location

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