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General NPI Number Information
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NPI Number | 1629262845
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Entity Type | Organization
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Legal Business Name | L & S FAMILY CARE HOME
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 1241 GOINS RD
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City | PEMBROKE
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State | NC
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Zip | 28372-8347
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Country | US
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Telephone | 910-521-1505
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Fax | 910-521-1585
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Provider Business Mailing Address
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Address Line | PO BOX 2895
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City | PEMBROKE
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State | NC
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Zip | 28372-2895
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Country | US
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Telephone | 910-521-1505
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Fax | 910-521-1585
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. LESIA SAMPSON HAMMONDS
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Credential |
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Telephone | 910-521-1505
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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 | 078-060
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License Number State | NC
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