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General NPI Number Information
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NPI Number | 1427389378
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Entity Type | Organization
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Legal Business Name | DIAL'S FAMILY CARE HOME #4
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 1685 CANAL RD C/O 1698 CANAL RD
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City | PEMBROKE
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State | NC
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Zip | 28372-9343
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Country | US
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Telephone | 910-318-9667
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Fax | 910-522-7327
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Provider Business Mailing Address
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Address Line | 1685 CANAL RD
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City | PEMBROKE
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State | NC
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Zip | 28372-9343
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Country | US
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Telephone | 910-318-9667
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Fax | 910-522-7327
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARLITA MOUJAHED
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Credential |
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Telephone | 910-318-9667
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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 | FCL-078-077
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License Number State | NC
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