Provider Demographics
NPI:1265559850
Name:BARBARAS WHITLEY ROAD GROUP HOME
Entity type:Organization
Organization Name:BARBARAS WHITLEY ROAD GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSE
Authorized Official - Phone:919-269-9882
Mailing Address - Street 1:182 WHITLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NC
Mailing Address - Zip Code:27557-8351
Mailing Address - Country:US
Mailing Address - Phone:919-269-9882
Mailing Address - Fax:919-269-9882
Practice Address - Street 1:182 WHITLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NC
Practice Address - Zip Code:27557-8351
Practice Address - Country:US
Practice Address - Phone:919-269-9882
Practice Address - Fax:919-269-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-051-116310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804584Medicaid