Healthcare Provider Details

I. General information

NPI: 1306963079
Provider Name (Legal Business Name): CHERRYS FAMILY CARE #2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 CHARLES TAYLOR ROAD
AULANDER NC
27805
US

IV. Provider business mailing address

743 CHARLES TAYLOR ROAD
AULANDER NC
27805
US

V. Phone/Fax

Practice location:
  • Phone: 252-794-2269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL008002
License Number StateNC

VIII. Authorized Official

Name: GLADYS CHERRY
Title or Position: ADMINISTRATOR
Credential:
Phone: 252-794-2269