Healthcare Provider Details

I. General information

NPI: 1407155120
Provider Name (Legal Business Name): CREEKVIEW FAMILY CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 DICKEY MILL RD
MEBANE NC
27302-9006
US

IV. Provider business mailing address

PO BOX 4094
BURLINGTON NC
27215-0901
US

V. Phone/Fax

Practice location:
  • Phone: 336-578-8374
  • Fax:
Mailing address:
  • Phone: 336-421-0435
  • Fax: 336-421-5871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: LAWANDA RAY
Title or Position: OWNER
Credential:
Phone: 336-421-0435