Provider Demographics
NPI:1003038779
Name:BAPTIST CHILDRENS HOMES OF NC INC
Entity Type:Organization
Organization Name:BAPTIST CHILDRENS HOMES OF NC INC
Other - Org Name:THREE FORKS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR DEVELOPMENTAL DISABILITIES
Authorized Official - Prefix:MS
Authorized Official - First Name:F.
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-474-1260
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27361-0338
Mailing Address - Country:US
Mailing Address - Phone:336-474-1272
Mailing Address - Fax:336-474-2346
Practice Address - Street 1:392 CAMP JOY RD
Practice Address - Street 2:
Practice Address - City:ZIONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28698-9759
Practice Address - Country:US
Practice Address - Phone:828-297-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST CHILDRENS HOMES OF NC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL095043320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMHL095043OtherLICENSE NUMBER