Healthcare Provider Details

I. General information

NPI: 1982935839
Provider Name (Legal Business Name): DIAL'S FAMILY CARE HOME #3
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 CANAL RD
PEMBROKE NC
28372-9343
US

IV. Provider business mailing address

1685 CANAL RD
PEMBROKE NC
28372-9343
US

V. Phone/Fax

Practice location:
  • Phone: 910-318-9667
  • Fax: 910-522-7327
Mailing address:
  • Phone: 910-318-9667
  • Fax: 910-522-7327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL-078-076
License Number StateNC

VIII. Authorized Official

Name: MARLITA MOUJAHED
Title or Position: ADMINISTRATOR
Credential:
Phone: 910-318-9667