Provider Demographics
NPI:1689772501
Name:NUBBING HILL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:NUBBING HILL HEALTHCARE, INC.
Other - Org Name:COUNTRYSIDE VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-980-1275
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:WADE
Mailing Address - State:NC
Mailing Address - Zip Code:28395-0309
Mailing Address - Country:US
Mailing Address - Phone:910-980-1275
Mailing Address - Fax:910-980-1118
Practice Address - Street 1:8100 DUNN ROAD
Practice Address - Street 2:
Practice Address - City:WADE
Practice Address - State:NC
Practice Address - Zip Code:28395
Practice Address - Country:US
Practice Address - Phone:910-980-1275
Practice Address - Fax:910-980-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-026-046310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804901Medicaid