Provider Demographics
NPI:1902978307
Name:HOMEPLACE OF NEW BERN, LLC
Entity Type:Organization
Organization Name:HOMEPLACE OF NEW BERN, LLC
Other - Org Name:HOMEPLACE OF NEW BERN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-637-7133
Mailing Address - Street 1:1309 MCCARTHY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2035
Mailing Address - Country:US
Mailing Address - Phone:252-637-7133
Mailing Address - Fax:252-637-7332
Practice Address - Street 1:1309 MCCARTHY BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2035
Practice Address - Country:US
Practice Address - Phone:252-637-7133
Practice Address - Fax:252-637-7332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-025-014310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804162Medicaid