Provider Demographics
NPI:1164583167
Name:MCKEITHEN FAMILY CARE HOME
Entity Type:Organization
Organization Name:MCKEITHEN FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEITHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-245-3567
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-0163
Mailing Address - Country:US
Mailing Address - Phone:910-245-3567
Mailing Address - Fax:
Practice Address - Street 1:287 FURR RD
Practice Address - Street 2:
Practice Address - City:VASS
Practice Address - State:NC
Practice Address - Zip Code:28394-0163
Practice Address - Country:US
Practice Address - Phone:910-245-3567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL063006311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home