Provider Demographics
NPI:1104013994
Name:PEARLS FAMILY CARE HOME #3
Entity Type:Organization
Organization Name:PEARLS FAMILY CARE HOME #3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM
Authorized Official - Prefix:
Authorized Official - First Name:PEARLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-326-3526
Mailing Address - Street 1:674 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28555-9120
Mailing Address - Country:US
Mailing Address - Phone:910-326-3526
Mailing Address - Fax:
Practice Address - Street 1:105 ASH CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-8503
Practice Address - Country:US
Practice Address - Phone:910-938-0251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC067009320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801235Medicaid