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General NPI Number Information
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NPI Number | 1619002250
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Entity Type | Organization
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Legal Business Name | GWEN FAMILY CARE HOME NO2
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 236 S ASHEBORO ST
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City | LIBERTY
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State | NC
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Zip | 27298-7503
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Country | US
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Telephone | 336-622-1842
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Fax | 336-622-9845
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Provider Business Mailing Address
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Address Line | 236 S ASHEBORO ST
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City | LIBERTY
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State | NC
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Zip | 27298-7503
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Country | US
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Telephone | 336-622-1842
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Fax | 336-622-9845
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Authorized Official
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Title or Position | ADMINASTRATOR
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Name | GWEN HUNTER
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Credential |
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Telephone | 336-622-1842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | FLC001058
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License Number State | NC
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