Provider Demographics
NPI:1225457898
Name:RANDOLPH FELLOWSHIP HOME INC.
Entity Type:Organization
Organization Name:RANDOLPH FELLOWSHIP HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-953-6222
Mailing Address - Street 1:PO BOX 2543
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-2543
Mailing Address - Country:US
Mailing Address - Phone:336-953-6222
Mailing Address - Fax:336-625-0527
Practice Address - Street 1:373 HILL ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5601
Practice Address - Country:US
Practice Address - Phone:336-625-1637
Practice Address - Fax:336-625-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL076-001253Z00000X
NCMHL076-007253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care