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General NPI Number Information
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NPI Number | 1831367267
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Entity Type | Organization
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Legal Business Name | K & G FAMILY CARE HOME
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 303 W FRANKLIN ST
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City | WARRENTON
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State | NC
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Zip | 27589-1937
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Country | US
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Telephone | 252-213-9012
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 601
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City | WARRENTON
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State | NC
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Zip | 27589-0601
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Country | US
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Telephone | 252-213-9012
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MS. MARY JONES SOMERVILLE
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Credential |
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Telephone | 252-213-9012
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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 | FCL-093-004
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License Number State | NC
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