1811011802 NPI number — CHEETHAM FAMILY CARE HOME

Table of content: (NPI 1811011802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811011802 NPI number — CHEETHAM FAMILY CARE HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEETHAM 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:
1811011802
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:
5309 FALLS OF NEUSE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27609-4700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-676-8062
Provider Business Mailing Address Fax Number:
919-676-8062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2726 NEWSOME ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27603-2956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-325-0671
Provider Business Practice Location Address Fax Number:
919-325-0671
Provider Enumeration Date:
03/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
RANSFORD
Authorized Official Middle Name:
NYLANDER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-795-8338

Provider Taxonomy Codes

  • Taxonomy code: 3104A0625X , with the licence number:  MHL-092-538-27G.5600 , 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)

  • Identifier: 7804824 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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