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General NPI Number Information
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NPI Number | 1205976347
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Entity Type | Organization
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Legal Business Name | WATLINGTON FAMILY CARE
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 1401 SHERROD WATLINGTON CIR
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City | GREENSBORO
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State | NC
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Zip | 27406-9463
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Country | US
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Telephone | 336-254-9662
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Fax | 336-292-3465
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Provider Business Mailing Address
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Address Line | 1401 SHERROD WATLINGTON CIR
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City | GREENSBORO
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State | NC
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Zip | 27406-9463
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Country | US
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Telephone | 336-254-9662
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Fax | 336-292-3090
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROMULUS THURMAN WATLINGTON
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Credential | QP
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Telephone | 336-254-9662
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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 | MHL-041-775
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License Number State | NC
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