Provider Demographics
NPI:1598796674
Name:BIRDMONT HEALTH CARE, LLC
Entity Type:Organization
Organization Name:BIRDMONT HEALTH CARE, LLC
Other - Org Name:CARRINGTON PLACE @ WYTHEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-723-3000
Mailing Address - Street 1:990 HOLSTON RD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-4105
Mailing Address - Country:US
Mailing Address - Phone:276-228-5595
Mailing Address - Fax:276-228-7343
Practice Address - Street 1:990 HOLSTON RD
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-4105
Practice Address - Country:US
Practice Address - Phone:276-228-5595
Practice Address - Fax:276-228-7343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2481314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA495349Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER