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General NPI Number Information
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NPI Number | 1396864245
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Entity Type | Organization
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Legal Business Name | PLEASANT HILL UCC FAMILY CARE HOME
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 393 CONNER DRIVE
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City | KIPLING
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State | NC
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Zip | 27543
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Country | US
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Telephone | 919-567-0929
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 55
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City | KIPLING
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State | NC
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Zip | 27543-0055
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | DONALD MCCOY
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Credential |
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Telephone | 919-779-2258
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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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