Healthcare Provider Details

I. General information

NPI: 1790947877
Provider Name (Legal Business Name): WEAVER'S FAMILY CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 W LEWISTOWN RD
MURFREESBORO NC
27855-9326
US

IV. Provider business mailing address

142 W LEWISTOWN RD
MURFREESBORO NC
27855-9326
US

V. Phone/Fax

Practice location:
  • Phone: 252-398-4824
  • Fax:
Mailing address:
  • Phone: 252-398-4824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License NumberFCLO46013
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCLO46013
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: VIRGINIA WEAVER
Title or Position: ADMINISTRATOR
Credential:
Phone: 252-398-4824