Presbyterian Home of Hawfields Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH0364 Issued in NC

Legal business name

PRESBYTERIAN HOME OF HAWFIELDS INC

Practice address

2502 South NC 119
Mebane, NC 27302

Phone

(336) 578-4728

NPI assigned

Jun 1, 2005

Organization subpart

No

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

Authorized official

Name

Max Kernodle

Title

Administrator

Phone

(336) 578-4701

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1871595033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2502 SOUTH NC 119",
            "city": "MEBANE",
            "state": "NC",
            "postal_code": "27302",
            "telephone_number": "336-578-4728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2502 SOUTH NC 119",
            "city": "MEBANE",
            "state": "NC",
            "postal_code": "27302",
            "telephone_number": "336-578-4728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN HOME OF HAWFIELDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-01",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "KERNODLE",
        "authorized_official_first_name": "MAX",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "336-578-4701"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0364",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406300",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3405363",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; 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.