MEDICARE: SCHENCK FAMILY CARE HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	FCL055001	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124288964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHENCK FAMILY CARE HOME

Provider Business Mailing Address
First Line	:	PO BOX 41
Second Line	:
City	:	IRON STATION
State	:	NC
Zip	:	28080-0041
Country	:	US
Telephone Number	:	704-735-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	4823 PAYSOUR POND RD
Second Line	:
City	:	IRON STATION
State	:	NC
Zip	:	28080-0041
Country	:	US
Telephone Number	:	704-735-6565
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LILLIE MAE SCHENCK
Credential	:
Telephone Number	:	704-735-6565

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	06/16/2008

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Directions to “SCHENCK FAMILY CARE HOME ” Practice Location

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