Healthcare Provider Details

I. General information

NPI: 1144353475
Provider Name (Legal Business Name): PERSONAL TOUCH FAMILY CARE HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9461 HWY 710 S.
ROWLAND NC
28383
US

IV. Provider business mailing address

9461 HIGHWAY 710 SOUTH 9461 HIGHWAY 710 SOUTH
ROWLAND NC
28383-8851
US

V. Phone/Fax

Practice location:
  • Phone: 910-422-9998
  • Fax:
Mailing address:
  • Phone: 910-422-9998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberFCL-078-019
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberFCL-078-045
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberFCL-078-047
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberFCL-078-018
License Number StateNC

VIII. Authorized Official

Name: EDNA CHAVIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 910-422-9998