Provider Demographics
NPI:1396864245
Name:PLEASANT HILL UCC FAMILY CARE HOME
Entity Type:Organization
Organization Name:PLEASANT HILL UCC FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-779-2258
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:KIPLING
Mailing Address - State:NC
Mailing Address - Zip Code:27543-0055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:393 CONNER DRIVE
Practice Address - Street 2:
Practice Address - City:KIPLING
Practice Address - State:NC
Practice Address - Zip Code:27543
Practice Address - Country:US
Practice Address - Phone:919-567-0929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC970599Medicaid