Organization
SCI - ROANOKE HOUSE
Active
Parent organization
SKILL CREATIONS INCORPORATED
Organization subpart
Yes
Provider details
NPI number
Legal business name
SKILL CREATIONS INCORPORATED
Authorized official
PAUL HACKMANN (CEO)
(919) 734-7398
Entity
Organization
Contact information
Practice address
105 CLEARFIELD DR, ROANOKE RAPIDS, NC 27870-3327
(252) 308-0902
Mailing address
PO BOX 1636, GOLDSBORO, NC 27533-1636
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-042-015
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340603T
—
NC
05
—
340605G
—
NC
05
—
3406065
—
NC
05
—
3406133
—
NC
05
—
3406234
—
NC
05
—
3406243
—
NC
05
—
3406250
—
NC
05
—
3406339
—
NC
05
—
3406347
—
NC
05
—
3406361
—
NC
05
—
3406370
—
NC
05
—
3406386
—
NC
05
—
3406401
—
NC
05
—
3406416
—
NC
05
—
3406425
—
NC
05
—
3416197
—
NC
Enumeration date
08/15/2006
Last updated
01/18/2019
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