=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821534074
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TURNER'S FAMILY CARE HOME, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2017
-----------------------------------------------------
Last Update Date | 01/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2105 NC 410 HWY
-----------------------------------------------------
City | BLADENBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28320-8053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-876-7424
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2105 NC 410 HWY
-----------------------------------------------------
City | BLADENBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28320-8053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-876-7424
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KELLY TURNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-876-7424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | FCL-009-030
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------