Provider Demographics
NPI:1609994821
Name:BMMGH-OPGH, INC.
Entity Type:Organization
Organization Name:BMMGH-OPGH, INC.
Other - Org Name:OUR PLACE GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:CARPENTER
Authorized Official - Last Name:DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-439-8041
Mailing Address - Street 1:6883 BURKEMONT RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-7673
Mailing Address - Country:US
Mailing Address - Phone:828-439-8041
Mailing Address - Fax:828-439-8041
Practice Address - Street 1:401 DREXEL RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-8322
Practice Address - Country:US
Practice Address - Phone:828-439-8041
Practice Address - Fax:828-439-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 012-091310400000X
NCMHL012118310400000X
311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804927Medicaid