Provider Demographics
NPI:1417951492
Name:FRIENDS HOMES, INC.
Entity Type:Organization
Organization Name:FRIENDS HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-292-8187
Mailing Address - Street 1:925 NEW GARDEN ROAD
Mailing Address - Street 2:FRIENDS HOMES INC
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3267
Mailing Address - Country:US
Mailing Address - Phone:336-292-8187
Mailing Address - Fax:336-854-9137
Practice Address - Street 1:925 NEW GARDEN ROAD
Practice Address - Street 2:FRIENDS HOMES INC
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-3267
Practice Address - Country:US
Practice Address - Phone:336-292-8187
Practice Address - Fax:336-854-9137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0190310400000X, 313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00833OtherBCBS PROVIDER NUMBER
NC3405148Medicaid
NC3406107Medicaid
NC3405148Medicaid