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General NPI Number Information
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NPI Number | 1073817680
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Entity Type | Organization
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Legal Business Name | HOME AWAY FROM HOME FAMILY CARE CENTER
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Dates
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Enumeration Date | 12/23/2010
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Last Update Date | 12/23/2010
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Provider Practice Location Address
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Address Line | 107 BRETT DR
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City | SHELBY
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State | NC
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Zip | 28152-9107
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Country | US
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Telephone | 704-313-7086
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 711
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City | SHELBY
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State | NC
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Zip | 28151-0711
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Country | US
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Telephone | 704-751-7602
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Fax | 704-918-1273
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TINA NORMAN
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Credential |
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Telephone | 704-751-7602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | FLC-023-040
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License Number State | NC
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