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General NPI Number Information
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NPI Number | 1154516565
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Entity Type | Organization
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Legal Business Name | L & L FAMILY CARE
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 1215 MOODY ST
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City | GREENSBORO
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State | NC
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Zip | 27401-4216
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Country | US
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Telephone | 336-274-1316
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Fax | 336-275-8091
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Provider Business Mailing Address
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Address Line | 1215 MOODY ST
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City | GREENSBORO
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State | NC
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Zip | 27401-4216
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Country | US
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Telephone | 336-274-1316
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Fax | 336-275-8091
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. CARMEN WHITTED
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Credential |
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Telephone | 336-274-1316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | FCL-041-015
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License Number State | NC
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