Provider Demographics
NPI:1013185644
Name:ELSIE-DORIS FAMILY CARE HOME
Entity Type:Organization
Organization Name:ELSIE-DORIS FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAQUITA
Authorized Official - Middle Name:TAMECIA
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-949-1175
Mailing Address - Street 1:PO BOX 3375
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27702-3375
Mailing Address - Country:US
Mailing Address - Phone:919-949-1175
Mailing Address - Fax:919-794-8106
Practice Address - Street 1:306 CHERRY GRV
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-3006
Practice Address - Country:US
Practice Address - Phone:919-949-1175
Practice Address - Fax:919-794-8106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-17
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL032088311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home