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General NPI Number Information
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NPI Number | 1457476913
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Entity Type | Organization
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Legal Business Name | WOLFE & JACKSON FAMILY CARE HOME
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 744 EAST SPRAGUE STREET
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City | WINSTON SALEM
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State | NC
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Zip | 27107-3246
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Country | US
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Telephone | 336-722-8354
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Fax | 336-722-8354
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Provider Business Mailing Address
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Address Line | PO BOX 12002
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City | WINSTON SALEM
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State | NC
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Zip | 27117-2002
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Country | US
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Telephone | 336-722-8354
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Fax | 336-722-8354
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Authorized Official
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Title or Position | ADMINSTATOR
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Name | MRS. ZELMA JACKSON WOLFE
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Credential |
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Telephone | 335-722-8354
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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 | FCL034020
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License Number State | NC
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