Provider Demographics
NPI:1144408394
Name:BULLOCK FAMILY CARE HOME OF NASHVILLE INC.
Entity Type:Organization
Organization Name:BULLOCK FAMILY CARE HOME OF NASHVILLE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:252-478-7331
Mailing Address - Street 1:619 S BODDIE ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-1229
Mailing Address - Country:US
Mailing Address - Phone:252-459-6601
Mailing Address - Fax:252-459-8014
Practice Address - Street 1:619 S BODDIE ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1229
Practice Address - Country:US
Practice Address - Phone:252-459-6601
Practice Address - Fax:252-459-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-064-008311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home