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General NPI Number Information
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NPI Number | 1275755639
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Entity Type | Organization
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Legal Business Name | DYNAMIC CARE HOME
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 739 AMBER DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-1886
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Country | US
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Telephone | 910-483-6416
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Fax | 910-483-5924
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Provider Business Mailing Address
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Address Line | PO BOX 504
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City | FAYETTEVILLE
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State | NC
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Zip | 28302-0504
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Country | US
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Telephone | 910-483-6416
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Fax | 910-483-5924
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. SHEARLDENA M TURNER
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Credential |
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Telephone | 910-483-6416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL-026-558
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License Number State | NC
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