Provider Demographics
NPI:1932107547
Name:NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY
Entity Type:Organization
Organization Name:NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY
Other - Org Name:NORTHERN SKILLED NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:HICKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-719-7102
Mailing Address - Street 1:PO BOX 1101
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-1101
Mailing Address - Country:US
Mailing Address - Phone:336-719-7000
Mailing Address - Fax:336-719-7199
Practice Address - Street 1:830 ROCKFORD ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5322
Practice Address - Country:US
Practice Address - Phone:336-719-7000
Practice Address - Fax:336-719-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0184314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405278Medicaid
NC3496547Medicaid
431531OtherANTHEM SNF PROVIDER #
NC0087JOtherBCBS OF NC SNF PROV NUM
=========006OtherTRICARE SNF PROVIDER #
NC3496547Medicaid