=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659052975
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEGGIES FAMILY CARE HOME LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2023
-----------------------------------------------------
Last Update Date | 07/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 619 GLENWOOD DR
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27330-8648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-452-7818
-----------------------------------------------------
Fax | 919-774-7705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 619 GLENWOOD DR
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27330-8648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-452-7818
-----------------------------------------------------
Fax | 919-774-7705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MARGARET W. WABERA
-----------------------------------------------------
Credential | OWNER
-----------------------------------------------------
Telephone | 919-452-7818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------