Provider Demographics
NPI:1144299702
Name:UNIVERSAL HEALTH CARE / NORTH RALEIGH, INC
Entity type:Organization
Organization Name:UNIVERSAL HEALTH CARE / NORTH RALEIGH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-459-2977
Mailing Address - Street 1:5201 CLARKS FORK DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5868
Mailing Address - Country:US
Mailing Address - Phone:919-872-7033
Mailing Address - Fax:919-872-7035
Practice Address - Street 1:5201 CLARKS FORK DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-5868
Practice Address - Country:US
Practice Address - Phone:919-872-7033
Practice Address - Fax:919-872-7035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0611314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC340614VMedicaid
NC7100087OtherEVERCARE PROVIDER NUMBER
NC001CWOtherBCBS PROVIDER NUMBER
NC3405529Medicaid
NC7100087OtherEVERCARE PROVIDER NUMBER
NC340614VMedicaid