MEDICARE: GARRISONS FAMILY CARE HOME INC

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	320800000X	Mental Illness Community Based Residential Treatment Facility	MHL092517	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	:	1669678355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARRISONS FAMILY CARE HOME INC

Provider Business Mailing Address
First Line	:	4333 DURHAM RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-8134
Country	:	US
Telephone Number	:	919-847-5248
Fax Number	:	919-847-5248

Provider Business Practice Location Address
First Line	:	4333 DURHAM RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-8134
Country	:	US
Telephone Number	:	919-847-5248
Fax Number	:	919-847-5248

Authorized Official
Title or Position	:	OWNER OPERATOR
Name	:	MRS. DELILAH JACKSON GARRISON
Credential	:	RN BSN
Telephone Number	:	919-847-5248

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	06/23/2008

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