Provider Demographics
NPI:1013067073
Name:BHM SALEM TERRACE LLC
Entity type:Organization
Organization Name:BHM SALEM TERRACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:KAZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-760-5740
Mailing Address - Street 1:2609 OLD SALISBURY RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-5903
Mailing Address - Country:US
Mailing Address - Phone:336-760-5740
Mailing Address - Fax:336-760-5741
Practice Address - Street 1:2609 OLD SALISBURY RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-5903
Practice Address - Country:US
Practice Address - Phone:336-760-5740
Practice Address - Fax:336-760-5741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-034-078310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805549Medicaid