Provider Demographics
NPI:1689713513
Name:BAPTIST CHILDREN'S HOMES OF NORTH CAROLINA, INC.
Entity Type:Organization
Organization Name:BAPTIST CHILDREN'S HOMES OF NORTH CAROLINA, INC.
Other - Org Name:KENNEDY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUAL
Authorized Official - Middle Name:V
Authorized Official - Last Name:BAREFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-474-1224
Mailing Address - Street 1:204 IDOL ST
Mailing Address - Street 2:PO BOX 338
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-4514
Mailing Address - Country:US
Mailing Address - Phone:336-474-1276
Mailing Address - Fax:336-472-4605
Practice Address - Street 1:2557 CEDAR DELL LN
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-9113
Practice Address - Country:US
Practice Address - Phone:252-522-0811
Practice Address - Fax:252-527-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCB00081251S00000X
NCMHL-054-120320800000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005678Medicaid