Provider Demographics
NPI:1255466876
Name:PIKEVILLE FAMILY CARE HOME
Entity Type:Organization
Organization Name:PIKEVILLE FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-222-9550
Mailing Address - Street 1:201 CLIFTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27863-9518
Mailing Address - Country:US
Mailing Address - Phone:919-222-9550
Mailing Address - Fax:919-242-1258
Practice Address - Street 1:201 CLIFTON RIDGE DR
Practice Address - Street 2:109 SE RAILROAD ST
Practice Address - City:PIKEVILLE
Practice Address - State:NC
Practice Address - Zip Code:27863-9518
Practice Address - Country:US
Practice Address - Phone:919-222-9550
Practice Address - Fax:919-242-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL096030261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service