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General NPI Number Information
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NPI Number | 1942484357
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Entity Type | Organization
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Legal Business Name | GRANTHAM FAMILY CARE HOME 1
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 642 DITCHBANK RD
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City | GOLDSBORO
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State | NC
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Zip | 27534-4842
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Country | US
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Telephone | 919-734-1848
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Fax |
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Provider Business Mailing Address
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Address Line | 301 SOUTH JOHN ST
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City | GOLDSBORO
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State | NC
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Zip | 27530-4842
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Country | US
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Telephone | 919-734-1848
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ELIZABETH E GRANTHAM
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Credential |
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Telephone | 919-734-1848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | FCL096018
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License Number State | NC
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