HINES GOOD SAMARITAN HOME NPI 1912172198

Custodial Care Facility (Adult Care Home) in Winston Salem, NC

Organization Custodial Care Facility Adult Care Home

About HINES GOOD SAMARITAN HOME

Hines Good Samaritan Home is a provider established in Winston Salem, North Carolina specializing in custodial care facility. The NPI number of Hines Good Samaritan Home is 1912172198 and was assigned on April 2008. The practitioner's primary taxonomy code is 311ZA0620X with license number FCL034077 (NC). The provider is registered as an organization and their NPI record was last updated 12 years ago. The authorized official of this NPI record is Mrs. Margaretta Hines Moore (Administrator)

NPI

1912172198

Provider NameHINES GOOD SAMARITAN HOME
Provider Location Address2317 ELBON DR WINSTON SALEM, NC 27105
Provider Mailing Address2224 MANCHESTER ST WINSTON SALEM, NC 27105
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date04-28-2008
Last Update Date05-05-2008

Primary Taxonomy

Taxonomy Code311ZA0620X
ClassificationCustodial Care Facility
TypeNursing & Custodial Care Facilities
SpecializationAdult Care Home
License No.FCL034077
License StateNC
Taxonomy DescriptionA custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.

Business Address

HINES GOOD SAMARITAN HOME
2317 ELBON DR
WINSTON SALEM, NC
ZIP 27105
Phone: (336) 722-7818

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Mailing Address

HINES GOOD SAMARITAN HOME
2224 MANCHESTER ST
WINSTON SALEM, NC
ZIP 27105
Phone: (336) 727-1308
Fax: (336) 723-8142

Authorized Official

Authorized Official NameMRS. MARGARETTA HINES MOORE
Authorized Official TitleADMINISTRATOR
Authorized Official Phone(336) 727-1308

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.