Provider Demographics
NPI:1629136197
Name:KORNEGAY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:KORNEGAY HEALTHCARE, INC.
Other - Org Name:GLENCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:KORNEGAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-275-0058
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349-0339
Mailing Address - Country:US
Mailing Address - Phone:910-275-0058
Mailing Address - Fax:910-275-0093
Practice Address - Street 1:214 LANEFIELD RD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NC
Practice Address - Zip Code:28398-8719
Practice Address - Country:US
Practice Address - Phone:910-293-3144
Practice Address - Fax:910-293-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNHO418314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3485252Medicaid
NC3455252Medicaid
NC3436396Medicaid
NCC81339Medicare UPIN
NC3436396Medicaid