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General NPI Number Information
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NPI Number | 1982115929
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Entity Type | Organization
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Legal Business Name | PANDORA FAMIYL CARE HOME LLC
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 10/17/2017
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Provider Practice Location Address
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Address Line | 924 HOBBS ST
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City | CLAYTON
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State | NC
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Zip | 27520-2933
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Country | US
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Telephone | 919-585-7542
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Fax | 919-585-7542
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Provider Business Mailing Address
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Address Line | 1650 BROWNAIRS LN
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City | RALEIGH
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State | NC
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Zip | 27610-3490
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Country | US
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Telephone | 919-673-4076
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Fax | 919-585-7542
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Authorized Official
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Title or Position | RN/ADMINISTRATOR
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Name | JUNE AKINYI OBURU
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Credential |
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Telephone | 919-673-4076
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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-051-063
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License Number State | NC
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