=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043799463
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRICE FAMILY CARE HOME LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2018
-----------------------------------------------------
Last Update Date | 08/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1385 BROWN RD
-----------------------------------------------------
City | JAMESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27846-9512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-792-4878
-----------------------------------------------------
Fax | 252-809-4814
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 21
-----------------------------------------------------
City | JAMESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27846-0021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-792-4878
-----------------------------------------------------
Fax | 252-809-4814
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATHLEEN A PERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-792-4878
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------