Healthcare Provider Details

I. General information

NPI: 1972593002
Provider Name (Legal Business Name): HAYESVILLE FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 HIGHWAY 69
HAYESVILLE NC
28904
US

IV. Provider business mailing address

2076 HIGHWAY 69
HAYESVILLE NC
28904
US

V. Phone/Fax

Practice location:
  • Phone: 828-389-1617
  • Fax: 828-389-1640
Mailing address:
  • Phone: 828-389-1617
  • Fax: 828-389-1640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. ALAN RAY BALL
Title or Position: OWNER MANAGER PROVIDER
Credential: PA
Phone: 828-389-1617