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General NPI Number Information
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NPI Number | 1841355070
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Entity Type | Organization
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Legal Business Name | MCLEAN FAMILY CARE HOME 2
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 83 ESTERVILLE RD
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-6411
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Country | US
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Telephone | 910-588-4619
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Fax | 910-588-6165
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Provider Business Mailing Address
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Address Line | 83 ESTERVILLE RD
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-6411
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Country | US
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Telephone | 910-588-4619
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Fax | 910-588-6165
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CORA LEE
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Credential |
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Telephone | 910-588-4619
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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 | FCL009-006
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License Number State | NC
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