Healthcare Provider Details

I. General information

NPI: 1285776518
Provider Name (Legal Business Name): ADAMS FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 GREENWOOD ST
EDEN NC
27288-5644
US

IV. Provider business mailing address

PO BOX 1157
FIELDALE VA
24089-1157
US

V. Phone/Fax

Practice location:
  • Phone: 336-627-1100
  • Fax:
Mailing address:
  • Phone: 276-957-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberFCL-079-018
License Number StateNC

VIII. Authorized Official

Name: MRS. JACQUELINE MOYER ADAMS
Title or Position: OWNER ADMINISTRATOR
Credential:
Phone: 336-627-1100