Healthcare Provider Details

I. General information

NPI: 1073654182
Provider Name (Legal Business Name): FAITH FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 CRESTVIEW DR
BURLINGTON NC
27217-1710
US

IV. Provider business mailing address

603 CRESTVIEW DR
BURLINGTON NC
27217-1710
US

V. Phone/Fax

Practice location:
  • Phone: 336-227-9992
  • Fax:
Mailing address:
  • Phone: 336-227-9992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberFCL001061
License Number StateNC

VIII. Authorized Official

Name: BOBBY JEAN GRAVES
Title or Position: ADMINISTRATOR
Credential: OWNER
Phone: 336-227-7953