MEDICARE: THE BEAR ENTERPRISE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
2	385H00000X	Respite Care
3	385HR2055X	Child Mental Illness Respite Care
4	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
5	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1912670266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BEAR ENTERPRISE, LLC

Provider Business Mailing Address
First Line	:	355 BECKWITH AVE
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-4258
Country	:	US
Telephone Number	:	919-634-4094
Fax Number	:

Provider Business Practice Location Address
First Line	:	9421 US 70 HWY WEST, CLAYTON , NC 27520
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-4258
Country	:	US
Telephone Number	:	919-634-4094
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STACEY WHITEHEAD
Credential	:
Telephone Number	:	919-538-8945

Provider Enumeration Date	:	07/30/2021
Last Update Date	:	08/29/2025

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Directions to “THE BEAR ENTERPRISE, LLC ” Practice Location

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