Provider Demographics
NPI:1639153919
Name:THE UNITED METHODIST RETIREMENT HOMES, INCORPORATED
Entity Type:Organization
Organization Name:THE UNITED METHODIST RETIREMENT HOMES, INCORPORATED
Other - Org Name:WESLEY PINES RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY/CORP EXEC DIR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-384-3001
Mailing Address - Street 1:1000 WESLEY PINES RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2148
Mailing Address - Country:US
Mailing Address - Phone:910-738-9692
Mailing Address - Fax:910-738-8905
Practice Address - Street 1:1000 WESLEY PINES RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358
Practice Address - Country:US
Practice Address - Phone:910-738-9692
Practice Address - Fax:910-738-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0240314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00881OtherBLUE CROSS BLUE SHIELD
NC3405180Medicaid
NC3406201Medicaid
NC7802223OtherASSITED LIVING PROVIDER
NC00881OtherBLUE CROSS BLUE SHIELD