Provider Demographics
NPI:1114106077
Name:MARION E. WALL
Entity Type:Organization
Organization Name:MARION E. WALL
Other - Org Name:CAPE FEAR ADULT DAY HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-323-4424
Mailing Address - Street 1:920 STAMPER RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4138
Mailing Address - Country:US
Mailing Address - Phone:910-323-4424
Mailing Address - Fax:910-323-3622
Practice Address - Street 1:920 STAMPER RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4138
Practice Address - Country:US
Practice Address - Phone:910-323-4424
Practice Address - Fax:910-323-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408729Medicaid