Provider Demographics
NPI:1013105618
Name:THE HERITAGE OF NEWPORT
Entity Type:Organization
Organization Name:THE HERITAGE OF NEWPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:VANN
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-992-3272
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27285-0628
Mailing Address - Country:US
Mailing Address - Phone:336-992-3272
Mailing Address - Fax:336-992-3480
Practice Address - Street 1:453 HOWARD BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-9244
Practice Address - Country:US
Practice Address - Phone:252-223-4554
Practice Address - Fax:252-223-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-016-017310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility