Healthcare Provider Details

I. General information

NPI: 1457656100
Provider Name (Legal Business Name): HUMPHREY FAMILY CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 BURTON CHAPEL RD
MEBANE NC
27302-7364
US

IV. Provider business mailing address

1156 HORSESHOE TRL
ALTON VA
24520-3084
US

V. Phone/Fax

Practice location:
  • Phone: 336-421-9560
  • Fax: 336-421-3935
Mailing address:
  • Phone: 434-575-5696
  • Fax: 434-575-5696

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: MR. DAVID A. HUMPHREY
Title or Position: OWNER
Credential:
Phone: 434-575-5696