Provider Demographics
NPI:1033243282
Name:ATTERBURY FAMILY CARE HOME
Entity Type:Organization
Organization Name:ATTERBURY FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-544-4114
Mailing Address - Street 1:5308 SILKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1651
Mailing Address - Country:US
Mailing Address - Phone:919-477-4556
Mailing Address - Fax:919-620-1636
Practice Address - Street 1:1802 ATTERBURY LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-2615
Practice Address - Country:US
Practice Address - Phone:919-477-4556
Practice Address - Fax:919-620-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL032022311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804307Medicaid