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General NPI Number Information
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NPI Number | 1073654182
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Entity Type | Organization
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Legal Business Name | FAITH FAMILY CARE
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 603 CRESTVIEW DR
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City | BURLINGTON
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State | NC
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Zip | 27217-1710
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Country | US
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Telephone | 336-227-9992
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Fax |
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Provider Business Mailing Address
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Address Line | 603 CRESTVIEW DR
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City | BURLINGTON
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State | NC
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Zip | 27217-1710
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Country | US
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Telephone | 336-227-9992
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BOBBY JEAN GRAVES
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Credential | OWNER
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Telephone | 336-227-7953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | FCL001061
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License Number State | NC
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