Provider Demographics
NPI:1568454262
Name:MORAVIAN HOME INCORPORATED
Entity type:Organization
Organization Name:MORAVIAN HOME INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TWISDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-767-8130
Mailing Address - Street 1:1000 SALEMTOWNE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3294
Mailing Address - Country:US
Mailing Address - Phone:336-767-8130
Mailing Address - Fax:336-767-4090
Practice Address - Street 1:1000 SALEMTOWNE DR
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3294
Practice Address - Country:US
Practice Address - Phone:336-767-8130
Practice Address - Fax:336-767-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0154314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC23892OtherPARTNERS MEDICARE
NC009AROtherBLUE CROSS BLUE SHIELD-NC
NC3405479Medicaid
NC340611VMedicare ID - Type UnspecifiedMEDICAID ICF PROVIDER #
NC009AROtherBLUE CROSS BLUE SHIELD-NC