Provider Demographics
NPI:1841390010
Name:TREYBURN HEALTHCARE, INC
Entity Type:Organization
Organization Name:TREYBURN HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-869-9195
Mailing Address - Street 1:2059 TORREDGE RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1767
Mailing Address - Country:US
Mailing Address - Phone:919-477-4474
Mailing Address - Fax:919-471-0298
Practice Address - Street 1:2059 TORREDGE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-1767
Practice Address - Country:US
Practice Address - Phone:919-477-4474
Practice Address - Fax:919-471-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0562314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3435458Medicaid
NC343607YMedicaid
NC3435458Medicaid