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General NPI Number Information
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NPI Number | 1225457898
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Entity Type | Organization
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Legal Business Name | RANDOLPH FELLOWSHIP HOME INC.
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 373 HILL ST
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City | ASHEBORO
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State | NC
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Zip | 27203-5601
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Country | US
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Telephone | 336-625-1637
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Fax | 336-625-0527
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Provider Business Mailing Address
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Address Line | PO BOX 2543
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City | ASHEBORO
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State | NC
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Zip | 27204-2543
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Country | US
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Telephone | 336-953-6222
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Fax | 336-625-0527
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LORI B. BRADY
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Credential |
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Telephone | 336-953-6222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | MHL076-007
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | MHL076-001
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License Number State | NC
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