Provider Demographics
NPI:1154463693
Name:LONG ACRES FAMILY CARE HOME#1
Entity Type:Organization
Organization Name:LONG ACRES FAMILY CARE HOME#1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANSFORD
Authorized Official - Middle Name:NYLANDER
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-795-8338
Mailing Address - Street 1:1133 VILLA GREEN CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2488
Mailing Address - Country:US
Mailing Address - Phone:910-676-8062
Mailing Address - Fax:
Practice Address - Street 1:400 PARNELL DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3402
Practice Address - Country:US
Practice Address - Phone:919-231-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-092-025261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802070Medicaid