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General NPI Number Information
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NPI Number | 1295850519
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Entity Type | Organization
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Legal Business Name | FAMILY AFFAIR CARE GROUP MANAGEMENT, INC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 2302 W MEADOWVIEW RD STE 208
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City | GREENSBORO
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State | NC
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Zip | 27407-3706
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Country | US
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Telephone | 336-274-1269
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Fax | 336-272-2387
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Provider Business Mailing Address
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Address Line | 2302 W MEADOWVIEW RD STE 208
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City | GREENSBORO
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State | NC
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Zip | 27407-3706
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Country | US
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Telephone | 336-274-1269
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Fax | 336-272-2387
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIE L GIBSON
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Credential |
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Telephone | 336-274-1269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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