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General NPI Number Information
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NPI Number | 1720380660
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Entity Type | Organization
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Legal Business Name | MARKS FAMILY CARE #1
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 11/29/2010
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Provider Practice Location Address
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Address Line | 476 HWY 87
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City | REIDSVILLE
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State | NC
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Zip | 27320
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Country | US
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Telephone | 336-349-2585
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Fax | 336-349-3174
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Provider Business Mailing Address
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Address Line | 1009 BENNETT ST
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City | GREENSBORO
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State | NC
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Zip | 27406-2004
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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 | ADMINSTRATIOR
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Name | MR. MARK WOODSON
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Credential |
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Telephone | 336-349-2585
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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 | FCL079081
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License Number State | NC
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