Healthcare Provider Details

I. General information

NPI: 1295954873
Provider Name (Legal Business Name): CHERRY'S FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 CHARLES TAYLOR RD
AULANDER NC
27805-9770
US

IV. Provider business mailing address

PO BOX 789
AULANDER NC
27805-0789
US

V. Phone/Fax

Practice location:
  • Phone: 252-348-4005
  • Fax: 252-345-8318
Mailing address:
  • Phone: 252-345-3732
  • Fax: 252-345-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL-008-019
License Number StateNC

VIII. Authorized Official

Name: MR. VANDERBILL CHERRY JR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 252-345-3732