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General NPI Number Information
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NPI Number | 1912133059
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Entity Type | Organization
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Legal Business Name | HOLMAN-HAMPTON SUNSHINE FAMILY CARE HOME
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 157 GLENDALE DR.
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City | EDEN
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State | NC
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Zip | 27288-0000
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Country | US
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Telephone | 336-589-0239
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 SHARPE AVE HOUSE #2
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City | EDEN
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State | NC
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Zip | 27288-3729
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Country | US
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Telephone | 336-589-0239
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT / ADMINISTRATOR
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Name | JANE LEVETTE HAMPTON
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Credential |
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Telephone | 336-589-0239
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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 | FCL079-063
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License Number State | NC
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