Provider Demographics
NPI:1548230188
Name:MASONIC AND EASTERN STAR HOME OF NORTH CAROLINA, INCORPORATED
Entity Type:Organization
Organization Name:MASONIC AND EASTERN STAR HOME OF NORTH CAROLINA, INCORPORATED
Other - Org Name:WHITESTONE: A MASONIC AND EASTERN STAR COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN, BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-299-0031
Mailing Address - Street 1:700 S HOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2321
Mailing Address - Country:US
Mailing Address - Phone:336-299-0031
Mailing Address - Fax:336-547-2999
Practice Address - Street 1:700 S HOLDEN RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2321
Practice Address - Country:US
Practice Address - Phone:336-299-0031
Practice Address - Fax:336-547-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0141313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3415506Medicaid
NC22871OtherPARTNERS INSURANCE
NC340614PMedicaid
NC7806239Medicaid
NC340614PMedicaid
NC7806239Medicaid
NC345506Medicare Oscar/Certification