1376769547 NPI number — B&V FAMILY HOMES SERVICES,LLC

Table of content: (NPI 1376769547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376769547 NPI number — B&V FAMILY HOMES SERVICES,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B&V FAMILY HOMES SERVICES,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MATTIE'S FAMILY CARE HOME
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376769547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45053 BALDWIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW LONDON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28127-8619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-463-4477
Provider Business Mailing Address Fax Number:
704-463-4477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45053 BALDWIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW LONDON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28127-8619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-463-1553
Provider Business Practice Location Address Fax Number:
704-463-5255
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OWENS
Authorized Official First Name:
BETTY
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
OFFICE MANAGER/COOWNER
Authorized Official Telephone Number:
704-463-1553

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  FCL084008 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com