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General NPI Number Information
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NPI Number | 1710006531
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Entity Type | Organization
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Legal Business Name | PROMISED LAND FAMILY SERVICES
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 821 S MAIN ST
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City | LAURINBURG
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State | NC
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Zip | 28352-4724
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Country | US
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Telephone | 910-276-0487
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Fax | 910-276-4123
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Provider Business Mailing Address
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Address Line | 821 S MAIN ST
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City | LAURINBURG
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State | NC
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Zip | 28352-4724
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Country | US
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Telephone | 910-276-0487
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Fax | 910-276-4123
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Authorized Official
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Title or Position | OWNER
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Name | MRS. GERVONIA SHERISH MANNING
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Credential |
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Telephone | 910-276-0487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC2538
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License Number State | NC
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