=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427198738
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOWERY'S FAMILY CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1113 E 2ND ST APT-G
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27101-4483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-723-0175
-----------------------------------------------------
Fax | 336-748-0961
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1113 E 2ND ST APT-G
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27101-4483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-723-0175
-----------------------------------------------------
Fax | 336-748-0961
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. UNDRAY LOWERY ROLLINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-723-0175
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC1602
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------