Provider Demographics
NPI:1912045295
Name:BARRINGTON ON THE GREEN PROPERTIES, LLC
Entity Type:Organization
Organization Name:BARRINGTON ON THE GREEN PROPERTIES, LLC
Other - Org Name:SUMMIT PLACE OF KINGS MOUNTAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-739-6772
Mailing Address - Street 1:1001 PHIFER RD
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3748
Mailing Address - Country:US
Mailing Address - Phone:704-739-6772
Mailing Address - Fax:704-739-6449
Practice Address - Street 1:1001 PHIFER RD
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3748
Practice Address - Country:US
Practice Address - Phone:704-739-6772
Practice Address - Fax:704-739-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-023-033310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805663Medicaid