1639355514 NPI number — BARNES FAMILY CARE HOME, INC

Table of content: (NPI 1639355514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639355514 NPI number — BARNES FAMILY CARE HOME, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARNES FAMILY CARE HOME, INC
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:
Provider Other Organization Name Type Code:
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:
1639355514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2503
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINSTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28502-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-286-6854
Provider Business Mailing Address Fax Number:
252-522-5941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1106 E CASWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINSTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28501-5308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-522-2634
Provider Business Practice Location Address Fax Number:
252-522-5941
Provider Enumeration Date:
01/10/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUDLEY
Authorized Official First Name:
CARRIE
Authorized Official Middle Name:
BARNES
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
252-286-6854

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  FCL-054-061 , 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)