MEDICARE: PRESBYTERIAN HOME OF HAWFIELDS 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	314000000X	Skilled Nursing Facility	NH0364	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871595033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESBYTERIAN HOME OF HAWFIELDS INC

Provider Business Mailing Address
First Line	:	2502 SOUTH NC 119
Second Line	:
City	:	MEBANE
State	:	NC
Zip	:	27302
Country	:	US
Telephone Number	:	336-578-4728
Fax Number	:

Provider Business Practice Location Address
First Line	:	2502 SOUTH NC 119
Second Line	:
City	:	MEBANE
State	:	NC
Zip	:	27302
Country	:	US
Telephone Number	:	336-578-4728
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MAX KERNODLE
Credential	:
Telephone Number	:	336-578-4701

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	11/15/2012

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