Healthcare Provider Details

I. General information

NPI: 1568779627
Provider Name (Legal Business Name): SESSOMS FAMILY CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 JERNIGAN AIRPORT RD
AHOSKIE NC
27910-9384
US

IV. Provider business mailing address

336 JERNIGAN AIRPORT RD
AHOSKIE NC
27910-9384
US

V. Phone/Fax

Practice location:
  • Phone: 252-332-8313
  • Fax:
Mailing address:
  • Phone: 252-332-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberFCL047008
License Number StateNC

VIII. Authorized Official

Name: EUKITA BARCO SESSOMS
Title or Position: OWNER/ADMINISTRATOR
Credential: MSW
Phone: 252-332-8313