Healthcare Provider Details

I. General information

NPI: 1982168571
Provider Name (Legal Business Name): FAMILY FIRST ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 GLOVENIA ST
EDEN NC
27288-4844
US

IV. Provider business mailing address

424 GLOVENIA ST
EDEN NC
27288-4844
US

V. Phone/Fax

Practice location:
  • Phone: 336-623-1093
  • Fax:
Mailing address:
  • Phone: 336-623-1093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: KASEY ROSS
Title or Position: OWNER
Credential:
Phone: 352-219-2262