Provider Demographics
NPI:1902001209
Name:THE UNITED METHODIST RETIREMENT HOMES, INCORPORATED
Entity Type:Organization
Organization Name:THE UNITED METHODIST RETIREMENT HOMES, INCORPORATED
Other - Org Name:CROASDAILE VILLAGE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-384-3001
Mailing Address - Street 1:2600 CROASDAILE FARM PKWY STE A500
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-1331
Mailing Address - Country:US
Mailing Address - Phone:919-384-2441
Mailing Address - Fax:919-384-2449
Practice Address - Street 1:2600 CROASDAILE FARM PKWY STE A500
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-1331
Practice Address - Country:US
Practice Address - Phone:919-384-2441
Practice Address - Fax:919-384-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1307251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEMPLOYER ID NUMBER