Provider Demographics
NPI:1003804188
Name:BAPTIST RETIREMENT HOMES OF NORTH CAROLINA INCORPORATED
Entity Type:Organization
Organization Name:BAPTIST RETIREMENT HOMES OF NORTH CAROLINA INCORPORATED
Other - Org Name:THE GARDENS OF TAYLOR GLEN
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:STILLERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-759-1044
Mailing Address - Street 1:PO BOX 11024
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27116-1024
Mailing Address - Country:US
Mailing Address - Phone:336-725-0202
Mailing Address - Fax:336-725-0449
Practice Address - Street 1:3700 TAYLOR GLEN LN
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3404
Practice Address - Country:US
Practice Address - Phone:704-788-6510
Practice Address - Fax:704-788-6506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH 0607310400000X
NCNH0607314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC345525Medicare ID - Type Unspecified
NC0966570005Medicare NSC