Provider Demographics
NPI:1891871901
Name:THE PRESBYTERIAN HOSPITAL
Entity Type:Organization
Organization Name:THE PRESBYTERIAN HOSPITAL
Other - Org Name:NOVANT HEALTH PRESBYTERIAN MEDICAL CENTER - SKILLED NURSING UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:MCDOWELL
Authorized Official - Last Name:HARGETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-384-5184
Mailing Address - Street 1:2085 FRONTIS PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5614
Mailing Address - Country:US
Mailing Address - Phone:336-277-7226
Mailing Address - Fax:336-277-9795
Practice Address - Street 1:200 HAWTHORNE LANE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-1101
Practice Address - Country:US
Practice Address - Phone:704-384-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PRESBYTERIAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC345467Medicare ID - Type Unspecified