MEDICARE: LOR-RAINE FAMILY CARE HOME, LLC

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	:	1669308003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOR-RAINE FAMILY CARE HOME, LLC

Provider Business Mailing Address
First Line	:	854 LONG IRON DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28312-8708
Country	:	US
Telephone Number	:	910-528-7921
Fax Number	:	910-528-7921

Provider Business Practice Location Address
First Line	:	2712 MORGANTON RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-4951
Country	:	US
Telephone Number	:	910-528-7921
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. TIJUANA DELROYA WHITE
Credential	:
Telephone Number	:	910-528-7921

Provider Enumeration Date	:	06/23/2026
Last Update Date	:	06/23/2026

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