Provider Demographics
NPI:1770623605
Name:R. BYRD COMMUNITY CARE SERVICES
Entity type:Organization
Organization Name:R. BYRD COMMUNITY CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-510-8761
Mailing Address - Street 1:220 SHADOWLAWN DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-9623
Mailing Address - Country:US
Mailing Address - Phone:336-510-8761
Mailing Address - Fax:336-510-7276
Practice Address - Street 1:220 SHADOWLAWN DR
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-9623
Practice Address - Country:US
Practice Address - Phone:336-510-8761
Practice Address - Fax:336-510-7276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409346Medicaid