Provider Demographics
NPI:1720412331
Name:THE UNITED METHODIST RETIREMENT HOMES, INCORPORATED
Entity Type:Organization
Organization Name:THE UNITED METHODIST RETIREMENT HOMES, INCORPORATED
Other - Org Name:CYPRESS GLEN RETIREMENT COMMUNITY
Other - Org Type:Other Name
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 1:100 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-1637
Mailing Address - Country:US
Mailing Address - Phone:252-830-0036
Mailing Address - Fax:252-830-0411
Practice Address - Street 1:100 HICKORY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858
Practice Address - Country:US
Practice Address - Phone:252-830-0036
Practice Address - Fax:252-830-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0473314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC009CHOtherBLUE CROSS BLUE SHIELD
NC345512Medicare Oscar/Certification