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General NPI Number Information
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NPI Number | 1790399301
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Entity Type | Organization
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Legal Business Name | BURRIS FAMILY PAYING IT FORWARD HOMECARE LLC
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 413 N PIEDMONT AVE
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-2440
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Country | US
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Telephone | 704-750-7080
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1754
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-1754
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Country | US
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Telephone | 980-483-8314
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Fax |
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Authorized Official
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Title or Position | OWNER/CNA
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Name | KAREN EVETTE BURRIS
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Credential | OWNER
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Telephone | 980-483-8314
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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 |
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License Number State |
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