Provider Demographics
NPI:1407031578
Name:HOLMAN-HAMPTON
Entity Type:Organization
Organization Name:HOLMAN-HAMPTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:LEVETTE
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-589-0239
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27289-0222
Mailing Address - Country:US
Mailing Address - Phone:336-627-0239
Mailing Address - Fax:
Practice Address - Street 1:1031 SHARPE AVE
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-3729
Practice Address - Country:US
Practice Address - Phone:336-627-0213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-079-062310400000X
NCFCL-079-063310400000X
NCFCL-079-064310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility