Healthcare Provider Details

I. General information

NPI: 1205976347
Provider Name (Legal Business Name): WATLINGTON FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SHERROD WATLINGTON CIR
GREENSBORO NC
27406-9463
US

IV. Provider business mailing address

1401 SHERROD WATLINGTON CIR
GREENSBORO NC
27406-9463
US

V. Phone/Fax

Practice location:
  • Phone: 336-254-9662
  • Fax: 336-292-3465
Mailing address:
  • Phone: 336-254-9662
  • Fax: 336-292-3090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberMHL-041-775
License Number StateNC

VIII. Authorized Official

Name: MR. ROMULUS THURMAN WATLINGTON
Title or Position: OWNER
Credential: QP
Phone: 336-254-9662