Basic Information
| Provider Information | |||||||||
| NPI: | 1013105618 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE HERITAGE OF NEWPORT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 628 | ||||||||
| Address2: | |||||||||
| City: | KERNERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272850628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369923272 | ||||||||
| FaxNumber: | 3369923480 | ||||||||
| Practice Location | |||||||||
| Address1: | 453 HOWARD BLVD | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285709244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522234554 | ||||||||
| FaxNumber: | 2522235350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 01/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | PIERCE | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | VANN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3369923272 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | HAL-016-017 | NC | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.