Provider Demographics
NPI:1134349822
Name:BUTTRY INC.
Entity type:Organization
Organization Name:BUTTRY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:BUTTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-945-8792
Mailing Address - Street 1:514 BAY LAKE DR.
Mailing Address - Street 2:
Mailing Address - City:CHOCOWINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27817-9094
Mailing Address - Country:US
Mailing Address - Phone:252-945-8792
Mailing Address - Fax:252-946-5900
Practice Address - Street 1:609 W 2ND ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4806
Practice Address - Country:US
Practice Address - Phone:252-945-8792
Practice Address - Fax:252-946-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-007-005310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801387Medicaid