MEDICARE: SCI NASH HOUSE II

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	313M00000X	Nursing Facility/Intermediate Care Facility	MHL-064-013	NC
2	315P00000X	Intellectual Disabilities Intermediate Care Facility	MHL-064-013	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	:	1427308659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCI NASH HOUSE II

Provider Business Mailing Address
First Line	:	PO BOX 1636
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27533-1636
Country	:	US
Telephone Number	:	919-734-7398
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 HAWTHORNE RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-3810
Country	:	US
Telephone Number	:	252-443-4383
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PAUL HACKMANN
Credential	:
Telephone Number	:	919-734-7398

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	01/18/2019

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Directions to “SCI NASH HOUSE II ” Practice Location

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