NPIMap

Organization Active NPI

Baptist House at Bethabara

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Winston Salem, NC
National Provider Identifier
1710022918
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
FCA034057 Issued in NC
Legal business name
BAPTIST HOUSE AT BETHABARA
Practice address
4643 Old Town Dr
Winston Salem, NC 27106-2616
Phone
(336) 727-1973
Fax
(336) 727-1547
NPI assigned
Feb 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. C. F. McDowell III
Title
Executive Vice President
Phone
(336) 474-1260

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X FCA034057 NC Primary

Addresses

Primary practice location

4643 Old Town Dr
Winston Salem, NC 27106-2616

Mailing address

PO Box 338
Thomasville, NC 27361-0338
Phone (336) 474-1260

Other identifiers 1

IdentifierTypeStateIssuer
7804105MedicaidNC

Other names 1

  • Baptist Children's Homes of NC, Inc. Other name

National Provider Directory

National Provider Directory
Tax ID family
Baptist Childrens Homes of NC Inc18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710022918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 338",
            "city": "THOMASVILLE",
            "state": "NC",
            "postal_code": "273610338",
            "telephone_number": "336-474-1260",
            "fax_number": "336-472-8157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4643 OLD TOWN DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271062616",
            "telephone_number": "336-727-1973",
            "fax_number": "336-727-1547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST HOUSE AT BETHABARA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCDOWELL",
        "authorized_official_first_name": "C.",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "336-474-1260",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "FCA034057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804105",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baptist Children's Homes of NC, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.