Provider Demographics
NPI:1265865489
Name:EASTWAY FAMILY CARE
Entity Type:Organization
Organization Name:EASTWAY FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEBANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-213-3839
Mailing Address - Street 1:108 EASTWAY LN
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3704
Mailing Address - Country:US
Mailing Address - Phone:336-436-0219
Mailing Address - Fax:336-270-3925
Practice Address - Street 1:108 EASTWAY LN
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3704
Practice Address - Country:US
Practice Address - Phone:336-436-0219
Practice Address - Fax:336-270-3925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-001-151311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility