Provider Demographics
NPI:1083983928
Name:MILDREDS FAMILY CARE,INC.
Entity Type:Organization
Organization Name:MILDREDS FAMILY CARE,INC.
Other - Org Name:MILDRED''S FAMILY CARE,INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:LAVALLE
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:336-421-0646
Mailing Address - Street 1:3592 MARSHALL GRAVES RD
Mailing Address - Street 2:
Mailing Address - City:YANCEYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27379-8630
Mailing Address - Country:US
Mailing Address - Phone:336-421-0646
Mailing Address - Fax:336-421-5666
Practice Address - Street 1:3592 MARSHALL GRAVES RD
Practice Address - Street 2:
Practice Address - City:YANCEYVILLE
Practice Address - State:NC
Practice Address - Zip Code:27379-8630
Practice Address - Country:US
Practice Address - Phone:336-213-2132
Practice Address - Fax:336-421-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-017-006311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility