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General NPI Number Information
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NPI Number | 1952560997
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Entity Type | Organization
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Legal Business Name | ETTALOVE FAMILY CARE HOME
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 1951 DIETRICH LN
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City | CHARLOTTE
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State | NC
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Zip | 28262-3526
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Country | US
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Telephone | 704-509-5596
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Fax | 704-509-5596
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Provider Business Mailing Address
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Address Line | 1951 DIETRICH LN
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City | CHARLOTTE
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State | NC
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Zip | 28262-3526
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Country | US
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Telephone | 704-509-5596
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Fax | 704-509-5596
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. TERESA YVETTE WASHINGTON
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Credential |
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Telephone | 704-509-5596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number | FCL-060-072
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License Number State | NC
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