Provider Demographics
NPI:1912104423
Name:HENDERSON CARE CENTER INC
Entity Type:Organization
Organization Name:HENDERSON CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-248-3800
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:125 HENDERSON CIRCLE
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-0648
Mailing Address - Country:US
Mailing Address - Phone:828-248-3800
Mailing Address - Fax:828-245-3597
Practice Address - Street 1:125 HENDERSON CIR
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-2584
Practice Address - Country:US
Practice Address - Phone:828-248-3800
Practice Address - Fax:828-245-3597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-081-010310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801774Medicaid