Provider Demographics
NPI:1518968890
Name:PRESBYTERIAN HOMES INC
Entity Type:Organization
Organization Name:PRESBYTERIAN HOMES INC
Other - Org Name:RIVER LANDING AT SANDY RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:HANOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-886-6553
Mailing Address - Street 1:1575 JOHN KNOX DR
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:NC
Mailing Address - Zip Code:27235-9662
Mailing Address - Country:US
Mailing Address - Phone:336-668-4900
Mailing Address - Fax:336-668-4911
Practice Address - Street 1:1575 JOHN KNOX DR
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:NC
Practice Address - Zip Code:27235-9662
Practice Address - Country:US
Practice Address - Phone:336-668-4900
Practice Address - Fax:336-668-4911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESBYTERIAN HOMES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-09
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405528Medicaid
NC3405528Medicaid