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General NPI Number Information
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NPI Number | 1669510905
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Entity Type | Organization
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Legal Business Name | FIELDS FOUNDATION, INC.
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1895 GREEN ACRES RD
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City | WILLIAMSTON
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State | NC
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Zip | 27892-8252
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Country | US
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Telephone | 252-792-6343
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Fax | 252-792-2881
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Provider Business Mailing Address
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Address Line | 1895 GREEN ACRES RD
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City | WILLIAMSTON
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State | NC
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Zip | 27892-8252
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Country | US
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Telephone | 252-792-6343
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Fax | 252-792-2881
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. SHIRLEY L. FIELDS
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Credential | DBA
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Telephone | 252-792-6343
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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 | FCL-058-008
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License Number State | NC
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