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General NPI Number Information
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NPI Number | 1801081310
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Entity Type | Organization
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Legal Business Name | LEE'S FAMILY CARE HOME
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 945 VAIDEN ROAD
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City | LOUISBURG
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State | NC
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Zip | 27549-8096
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Country | US
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Telephone | 919-853-3359
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Fax | 919-853-3359
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Provider Business Mailing Address
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Address Line | 945 VAIDEN RD
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City | LOUISBURG
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State | NC
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Zip | 27549-8096
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Country | US
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Telephone | 919-853-3359
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Fax | 919-853-3359
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. WILLIE JAMES LEE
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Credential |
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Telephone | 919-853-3359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number | FCL035-002
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License Number State | NC
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