Provider Demographics
NPI:1164556072
Name:QUAKER MEADOWS FCH - BURKE REST HOME INC
Entity Type:Organization
Organization Name:QUAKER MEADOWS FCH - BURKE REST HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-433-5875
Mailing Address - Street 1:125 CAMELLIA GARDEN ST
Mailing Address - Street 2:QUAKER MEADOWS FCH
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-8207
Mailing Address - Country:US
Mailing Address - Phone:828-433-5875
Mailing Address - Fax:
Practice Address - Street 1:125 CAMELLIA GARDEN ST
Practice Address - Street 2:QUAKER MEADOWS FCH
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-8207
Practice Address - Country:US
Practice Address - Phone:828-433-5875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL012014310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801425Medicaid