Provider Demographics
NPI:1295704997
Name:UNIVERSAL HEALTH CARE / BLUMENTHAL INC
Entity type:Organization
Organization Name:UNIVERSAL HEALTH CARE / BLUMENTHAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-633-0055
Mailing Address - Street 1:3724 WIRELESS DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-3312
Mailing Address - Country:US
Mailing Address - Phone:336-540-9991
Mailing Address - Fax:336-540-9375
Practice Address - Street 1:3724 WIRELESS DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-3312
Practice Address - Country:US
Practice Address - Phone:336-540-9991
Practice Address - Fax:336-540-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0135314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00935OtherBCBS PROVIDER NUMBER
NC3415006Medicaid
NC3416108Medicaid
NC3416108Medicaid