Healthcare Provider Details

I. General information

NPI: 1376612952
Provider Name (Legal Business Name): ALLEN FAMILY LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 LAKEVIEW RD
CHERRYVILLE NC
28021-8603
US

IV. Provider business mailing address

304 LAKEVIEW RD
CHERRYVILLE NC
28021-8603
US

V. Phone/Fax

Practice location:
  • Phone: 704-445-8261
  • Fax: 704-445-8261
Mailing address:
  • Phone: 704-445-8261
  • Fax: 704-445-8261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY ALLEN
Title or Position: VICE PRESIDENT
Credential:
Phone: 704-445-8261