Provider Demographics
NPI:1952037566
Name:HARVEY, BETTINA (ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:BETTINA
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 BH HARVEY TRL LOT H
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-7618
Mailing Address - Country:US
Mailing Address - Phone:336-539-5176
Mailing Address - Fax:
Practice Address - Street 1:667 BH HARVEY TRL LOT H
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-7618
Practice Address - Country:US
Practice Address - Phone:336-350-7685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFOO184376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator