Healthcare Provider Details

I. General information

NPI: 1780338566
Provider Name (Legal Business Name): TAYLOR FAMILY CARE 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 BERTHA WILSON RD
BLANCH NC
27212-9795
US

IV. Provider business mailing address

1136 BERTHA WILSON RD
BLANCH NC
27212-9795
US

V. Phone/Fax

Practice location:
  • Phone: 336-694-1878
  • Fax: 336-694-1878
Mailing address:
  • Phone: 336-694-1878
  • Fax: 336-694-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ESTELLA JOANN SPANN
Title or Position: OWNER / SUPERVISOR IN CHARGE
Credential:
Phone: 336-694-1878