Organization
REGINALD L. HARRIS ANNEX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG JAMES (ADMINISTRATION)
(336) 599-2121
Entity
Organization
Contact information
Practice address
615 RIDGE RD, ROXBORO, NC 27573-4629
(336) 599-2121
Mailing address
615 RIDGE RD, ROXBORO, NC 27573-4629
(336) 599-2121
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
H0066
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00904
BLUE CROSS PROVIDER #
NC
05
—
3405004
—
NC
05
—
3496588
—
NC
Enumeration date
03/21/2006
Last updated
08/22/2020
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