1780803270 NPI number — DAPHNE'S FAMILY CARE HOME

Table of content: (NPI 1780803270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780803270 NPI number — DAPHNE'S FAMILY CARE HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAPHNE'S FAMILY CARE HOME
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:
1780803270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1027
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REIDSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27323-1027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-342-4040
Provider Business Mailing Address Fax Number:
336-342-4999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1802 AMOS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REIDSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27320-6204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-342-4040
Provider Business Practice Location Address Fax Number:
336-342-4999
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMSON
Authorized Official First Name:
DAPHNE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
336-342-4040

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  FCL-079-024 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311ZA0620X , with the licence number: FCL-079-047 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 311ZA0620X , with the licence number: FCL-079-029 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311ZA0620X , with the licence number: FCL-079-025 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311ZA0620X , with the licence number: FCL-079-038 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7803345 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7803346 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7803358 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7804199 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7801517 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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