Healthcare Provider Details

I. General information

NPI: 1437399524
Provider Name (Legal Business Name): KNOXS HOUSE FAMILY CARE II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 DUCK POINT DR
MONROE NC
28110-8813
US

IV. Provider business mailing address

2918 DUCK POINT DR
MONROE NC
28110-8813
US

V. Phone/Fax

Practice location:
  • Phone: 704-475-5821
  • Fax: 704-475-7207
Mailing address:
  • Phone: 704-475-5821
  • Fax: 704-475-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL090-028
License Number StateNC

VIII. Authorized Official

Name: MRS. SHELLEY YVONNE KNOX
Title or Position: ADMINISTRATOR
Credential: OWNER
Phone: 704-475-5821