Provider Demographics
NPI:1699706606
Name:WARREN HILLS, A PERSONAL CARE AND NURSING FACILITY
Entity type:Organization
Organization Name:WARREN HILLS, A PERSONAL CARE AND NURSING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-257-2011
Mailing Address - Street 1:PO BOX 618
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27589-0618
Mailing Address - Country:US
Mailing Address - Phone:252-257-2011
Mailing Address - Fax:252-257-5164
Practice Address - Street 1:864 US HWY. 158 BUSINESS WEST
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589
Practice Address - Country:US
Practice Address - Phone:252-257-2011
Practice Address - Fax:252-257-5164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0360310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406293Medicaid
NC00974OtherBCBS PROVIDER NUMBER
NC7801103Medicaid
NC3405240Medicaid
NC345240Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NC7801103Medicaid