Provider Demographics
NPI:1477641694
Name:MARYFIELD, INC.
Entity Type:Organization
Organization Name:MARYFIELD, INC.
Other - Org Name:PENNYBYRN AT MARYFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DENMAN
Authorized Official - Last Name:TOTH
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, MBA
Authorized Official - Phone:336-886-2444
Mailing Address - Street 1:1315 GREENSBORO RD
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-2611
Mailing Address - Country:US
Mailing Address - Phone:336-886-2444
Mailing Address - Fax:336-886-4036
Practice Address - Street 1:1315 GREENSBORO RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-2611
Practice Address - Country:US
Practice Address - Phone:336-886-2444
Practice Address - Fax:336-886-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0005314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405093Medicaid
=========OtherFED TAX ID NUMBER
=========OtherFED TAX ID NUMBER