Provider Demographics
NPI:1386845303
Name:BAPTIST RETIREMENT HOMES OF NORTH CAROLINA, INCORPORATED
Entity Type:Organization
Organization Name:BAPTIST RETIREMENT HOMES OF NORTH CAROLINA, INCORPORATED
Other - Org Name:THE HAMILTON BAPTIST HOME
Other - Org Type:Doing Business As
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:336-725-0300
Mailing Address - Fax:336-725-0449
Practice Address - Street 1:301 NORTH RAILROAD STREET
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NC
Practice Address - Zip Code:27840
Practice Address - Country:US
Practice Address - Phone:252-798-5901
Practice Address - Fax:252-798-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-058-001311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801287Medicaid