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General NPI Number Information
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NPI Number | 1184766610
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Entity Type | Organization
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Legal Business Name | CHAM-NET FAMILY CARE HOME
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1124 THOMAS ST
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City | BURLINGTON
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State | NC
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Zip | 27215-6965
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Country | US
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Telephone | 336-227-0703
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Fax | 336-229-1081
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Provider Business Mailing Address
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Address Line | 1010 RICHMOND AVE
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City | BURLINGTON
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State | NC
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Zip | 27217-1525
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Country | US
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Telephone | 336-226-5060
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Fax | 336-229-1081
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. CLARA LOUISE GRIFFIS
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Credential |
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Telephone | 336-226-5060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | FCL-001-062
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License Number State | NC
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