MEDICARE: EUGENE C DAVENPORT

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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1437609179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUGENE C DAVENPORT

Provider Business Mailing Address
First Line	:	1327 ECHO LAKE LN
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27803-2564
Country	:	US
Telephone Number	:	252-395-0263
Fax Number	:

Provider Business Practice Location Address
First Line	:	1327 ECHO LAKE LN
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27803-2564
Country	:	US
Telephone Number	:	252-395-0263
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EUGENE CARROLL DAVENPORT
Credential	:
Telephone Number	:	252-395-0263

Provider Enumeration Date	:	10/06/2016
Last Update Date	:	10/06/2016

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Directions to “EUGENE C DAVENPORT ” Practice Location

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