Healthcare Provider Details

I. General information

NPI: 1548581317
Provider Name (Legal Business Name): PASSIONATE CARE FAMILY CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 US HIGHWAY 70 W
SMITHFIELD NC
27577-7618
US

IV. Provider business mailing address

3181 US HIGHWAY 70 W
SMITHFIELD NC
27577-7618
US

V. Phone/Fax

Practice location:
  • Phone: 919-934-2425
  • Fax:
Mailing address:
  • Phone: 919-934-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHANTAE ALTMAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 919-934-2425