MEDICARE: SAVANNAH FAMILY CARE HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	063009	NC

General Provider Information

NPI Number	:	1629137484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAVANNAH FAMILY CARE HOME

Provider Business Mailing Address
First Line	:	128 N CARLISLE ST
Second Line	:
City	:	SOUTHERN PINES
State	:	NC
Zip	:	28387-3938
Country	:	US
Telephone Number	:	910-695-3665
Fax Number	:	910-695-3665

Provider Business Practice Location Address
First Line	:	128 N CARLISLE ST
Second Line	:
City	:	SOUTHERN PINES
State	:	NC
Zip	:	28387-3938
Country	:	US
Telephone Number	:	910-695-3665
Fax Number	:	910-695-3665

Authorized Official
Title or Position	:	ADMINISTRATOR OWNER
Name	:	SHARRONDA MELVIN SAVANNAH
Credential	:
Telephone Number	:	910-695-3665

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	08/22/2020

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