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General NPI Number Information
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NPI Number | 1497874002
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Entity Type | Organization
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Legal Business Name | NELLIES FAMILY CARE HOME INC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 1608 FALLSTON ROAD
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City | SHELBY
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State | NC
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Zip | 28150-4619
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Country | US
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Telephone | 704-482-0340
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Fax |
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Provider Business Mailing Address
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Address Line | 1608 FALLSTON RD
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City | SHELBY
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State | NC
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Zip | 28150-3365
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Country | US
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Telephone | 704-482-0340
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NELL HERNANDEZ
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Credential |
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Telephone | 704-480-1332
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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 023-015
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License Number State | NC
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