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General NPI Number Information
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NPI Number | 1528102803
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Entity Type | Organization
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Legal Business Name | MURRAY FORK HOME CARE
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 209 MURRAY FORK DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-0902
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Country | US
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Telephone | 910-480-4181
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Fax | 910-480-4182
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Provider Business Mailing Address
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Address Line | PO BOX 35674
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-0674
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Country | US
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Telephone | 910-480-4181
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Fax | 910-480-4182
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DEBRA BIDDLE
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Credential |
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Telephone | 910-670-0917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-026-647
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License Number State | NC
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