Provider Demographics
NPI:1275754491
Name:GEORGANN Y. MATHIS
Entity Type:Organization
Organization Name:GEORGANN Y. MATHIS
Other - Org Name:WHITE OAK FAMILY CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGANN
Authorized Official - Middle Name:YEAGER
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-688-2965
Mailing Address - Street 1:244 MCMAHAN LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28705-8178
Mailing Address - Country:US
Mailing Address - Phone:828-688-2965
Mailing Address - Fax:828-688-2965
Practice Address - Street 1:244 MCMAHAN LN
Practice Address - Street 2:
Practice Address - City:BAKERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28705-8178
Practice Address - Country:US
Practice Address - Phone:828-688-2965
Practice Address - Fax:828-688-2965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFLC-061-009311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility