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General NPI Number Information
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NPI Number | 1649709627
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Entity Type | Organization
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Legal Business Name | LIVING YOUR DREAM FCH, LLC
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 06/05/2017
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Provider Practice Location Address
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Address Line | 603 HEARTWOOD RD
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City | GRIMESLAND
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State | NC
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Zip | 27837-9787
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Country | US
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Telephone | 252-689-5868
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 350
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City | GREENVILLE
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State | NC
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Zip | 27835-0350
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GLADYS MARIE BELL
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Credential |
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Telephone | 252-916-9018
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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 | FCL074-049
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License Number State | NC
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