Healthcare Provider Details

I. General information

NPI: 1487773008
Provider Name (Legal Business Name): MEBANE'S FAMILY CARE #2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 LAKESIDE AVE
BURLINGTON NC
27217-9724
US

IV. Provider business mailing address

939 LAKESIDE AVE
BURLINGTON NC
27217-9724
US

V. Phone/Fax

Practice location:
  • Phone: 336-227-0569
  • Fax: 336-227-1460
Mailing address:
  • Phone: 336-227-0569
  • Fax: 336-227-1460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberFCL-001-026
License Number StateNC

VIII. Authorized Official

Name: MRS. BARBARA J. MEBANE
Title or Position: ADMINISTRATOR
Credential:
Phone: 336-227-0569