Healthcare Provider Details

I. General information

NPI: 1720380660
Provider Name (Legal Business Name): MARKS FAMILY CARE #1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 HWY 87
REIDSVILLE NC
27320
US

IV. Provider business mailing address

1009 BENNETT ST
GREENSBORO NC
27406-2004
US

V. Phone/Fax

Practice location:
  • Phone: 336-349-2585
  • Fax: 336-349-3174
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL079081
License Number StateNC

VIII. Authorized Official

Name: MR. MARK WOODSON
Title or Position: ADMINSTRATIOR
Credential:
Phone: 336-349-2585