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General NPI Number Information
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NPI Number | 1710161120
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Entity Type | Organization
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Legal Business Name | OAK GROVE FAMILY CARE HOME
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 12/20/2007
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Provider Practice Location Address
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Address Line | 583 SASSAFRAS RD
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City | BLADENBORO
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State | NC
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Zip | 28320-5925
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Country | US
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Telephone | 910-648-2176
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Fax |
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Provider Business Mailing Address
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Address Line | 583 SASSAFRAS RD
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City | BLADENBORO
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State | NC
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Zip | 28320-5925
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Country | US
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Telephone | 910-648-2176
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EVELYN TODD
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Credential |
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Telephone | 910-648-2176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | FCH009008
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License Number State | NC
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