Basic Information
| Provider Information | |||||||||
| NPI: | 1649254582 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTURY CARE OF NEW BERN, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3003 KENSINGTON PARK DR | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285604401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526381818 | ||||||||
| FaxNumber: | 2526389308 | ||||||||
| Practice Location | |||||||||
| Address1: | 3003 KENSINGTON PARK DR | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285604401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526381818 | ||||||||
| FaxNumber: | 2526389308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 07/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | GILLIAM | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9194678686 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH0567 | NC | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 7801800 | 05 | NC | MEDICAID | 3415465 | 05 | NC | MEDICAID | 341608U | 05 | NC | MEDICAID | 0091V | 01 | NC | BLUE BROSS BLUE SHIELD | OTHER |