Provider Demographics
NPI:1972587376
Name:THE UNITED METHODIST RETIREMENT HOMES, INCORPORATED
Entity Type:Organization
Organization Name:THE UNITED METHODIST RETIREMENT HOMES, INCORPORATED
Other - Org Name:CROASDAILE VILLAGE
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 PARKWAY
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:919-384-2000
Mailing Address - Fax:919-384-2480
Practice Address - Street 1:2600 CROASDAILE FARM PKWY
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:919-384-2000
Practice Address - Fax:919-384-2480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0587314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405501Medicaid
NC340612YMedicaid
NC00880OtherBCBS
NC00880OtherBCBS