Healthcare Provider Details

I. General information

NPI: 1386988061
Provider Name (Legal Business Name): THE EAST FAMILY CARE 1&2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 WORSHAM MILL RD 830 WORSHAM MILL RD
RUFFIN NC
27326-9410
US

IV. Provider business mailing address

843 WORSHAM MILL RD 830 WORSHAM MILL RD
RUFFIN NC
27326-9410
US

V. Phone/Fax

Practice location:
  • Phone: 336-939-7678
  • Fax: 336-939-9444
Mailing address:
  • Phone: 336-939-7678
  • Fax: 336-939-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL-079-003
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL 079-002
License Number StateNC

VIII. Authorized Official

Name: MRS. MERNELLA MAI SHEFFIELD
Title or Position: ADMINISTRATER
Credential:
Phone: 336-939-7678