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General NPI Number Information
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NPI Number | 1619202710
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Entity Type | Organization
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Legal Business Name | UNLIMITED POSSIBILITIES FAMILY HOME CARE
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Dates
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Enumeration Date | 10/07/2009
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Last Update Date | 10/07/2009
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Provider Practice Location Address
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Address Line | 5003 TEWKESBURY RD
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City | CHARLOTTE
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State | NC
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Zip | 28269-4557
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Country | US
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Telephone | 704-453-6753
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Fax | 704-749-9522
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Provider Business Mailing Address
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Address Line | 5226 ADDISON DR
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City | CHARLOTTE
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State | NC
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Zip | 28211-4135
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Country | US
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Telephone | 704-453-6753
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Fax | 704-749-9522
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MR. JAMES HENRY SCRUGGS JR.
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Credential |
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Telephone | 704-453-6753
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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 | FCL000100
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License Number State | NC
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