Provider Demographics
NPI:1205088143
Name:BETHESDA HEALTH CARE FACILITY
Entity type:Organization
Organization Name:BETHESDA HEALTH CARE FACILITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-323-3223
Mailing Address - Street 1:3532 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:EASTOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28312-8894
Mailing Address - Country:US
Mailing Address - Phone:910-323-3223
Mailing Address - Fax:910-323-0177
Practice Address - Street 1:3532 DUNN RD
Practice Address - Street 2:
Practice Address - City:EASTOVER
Practice Address - State:NC
Practice Address - Zip Code:28312-8894
Practice Address - Country:US
Practice Address - Phone:910-323-3223
Practice Address - Fax:910-323-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC922968313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405212Medicaid
NC3406188Medicaid
NC00956OtherBCBS
NC3406188Medicaid