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General NPI Number Information
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NPI Number | 1417229113
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Entity Type | Organization
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Legal Business Name | LILLIAN BROTHERS FAMILY CARE HOME LLC
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 533 WEIGHT STATION RD
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City | HERTFORD
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State | NC
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Zip | 27944-8562
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Country | US
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Telephone | 252-264-3185
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Fax |
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Provider Business Mailing Address
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Address Line | 533 WEIGHT STATION RD
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City | HERTFORD
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State | NC
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Zip | 27944-8562
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Country | US
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Telephone | 252-264-3185
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. BERNADINE SMITH
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Credential | MPA
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Telephone | 757-310-1430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | FCL-072-009
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | FCL-072-009
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License Number State | NC
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