MEDICARE: HAMILTON 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1699247056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAMILTON FAMILY CARE HOME LLC

Provider Business Mailing Address
First Line	:	13418 HAMILTON RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-8200
Country	:	US
Telephone Number	:	980-209-0062
Fax Number	:	980-209-0062

Provider Business Practice Location Address
First Line	:	13418 HAMILTON RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-8200
Country	:	US
Telephone Number	:	980-209-0062
Fax Number	:	980-209-0062

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SEEDY SAIDYKHAN
Credential	:
Telephone Number	:	704-231-5284

Provider Enumeration Date	:	12/26/2018
Last Update Date	:	12/26/2018

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