Provider Demographics
NPI:1073654182
Name:FAITH FAMILY CARE
Entity Type:Organization
Organization Name:FAITH FAMILY CARE
Other - Org Name:BOBBY JEAN GRAVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:336-227-7953
Mailing Address - Street 1:603 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-1710
Mailing Address - Country:US
Mailing Address - Phone:336-227-9992
Mailing Address - Fax:
Practice Address - Street 1:603 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-1710
Practice Address - Country:US
Practice Address - Phone:336-227-9992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL0010613104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803113Medicaid