Provider Demographics
NPI:1326365511
Name:THE BYRD HEALTHCARE GROUP OF NORTH CAROLINA, LLC
Entity type:Organization
Organization Name:THE BYRD HEALTHCARE GROUP OF NORTH CAROLINA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-493-7575
Mailing Address - Street 1:2 WALDEN RIDGE DR
Mailing Address - Street 2:UNIT 20-A
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8597
Mailing Address - Country:US
Mailing Address - Phone:828-274-2082
Mailing Address - Fax:828-274-3201
Practice Address - Street 1:2 WALDEN RIDGE DR
Practice Address - Street 2:UNIT 20-A
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8597
Practice Address - Country:US
Practice Address - Phone:828-274-2082
Practice Address - Fax:828-274-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2046251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7100650Medicaid