Provider Demographics
NPI:1033259403
Name:BAPTIST CHILDREN'S HOMES OF NORTH CAROLINA
Entity Type:Organization
Organization Name:BAPTIST CHILDREN'S HOMES OF NORTH CAROLINA
Other - Org Name:WESTERN AREA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:BAREFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-474-1224
Mailing Address - Street 1:204 IDOL ST
Mailing Address - Street 2:P. O. BOX 338
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-4514
Mailing Address - Country:US
Mailing Address - Phone:336-474-1276
Mailing Address - Fax:336-472-4605
Practice Address - Street 1:111 SNEED DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8468
Practice Address - Country:US
Practice Address - Phone:828-627-9254
Practice Address - Fax:828-627-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCB00016251S00000X, 320800000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005611Medicaid