Provider Demographics
NPI:1417002684
Name:THE BAKERS HOUSE
Entity Type:Organization
Organization Name:THE BAKERS HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TABETHA
Authorized Official - Middle Name:TENIKA
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-274-6874
Mailing Address - Street 1:1004 RICHARDSON ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-2951
Mailing Address - Country:US
Mailing Address - Phone:336-274-6874
Mailing Address - Fax:
Practice Address - Street 1:1004 RICHARDSON ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-2951
Practice Address - Country:US
Practice Address - Phone:336-274-6874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-744311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC041-744OtherMHL-LICENSE NUMBER
NC7805161Medicaid
NC8301455Medicaid