Healthcare Provider Details

I. General information

NPI: 1306988530
Provider Name (Legal Business Name): LONG ACRES FAMILY CARE HOME #2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 PARNELL DR
RALEIGH NC
27610-3402
US

IV. Provider business mailing address

1133 VILLA GREEN CT
RALEIGH NC
27612-2488
US

V. Phone/Fax

Practice location:
  • Phone: 919-231-1404
  • Fax:
Mailing address:
  • Phone: 919-676-8062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL-092-026
License Number StateNC

VIII. Authorized Official

Name: MR. RANSFORD NYLANDER THOMPSON
Title or Position: PRESIDENT
Credential:
Phone: 919-795-8338