Provider Demographics
NPI:1326264516
Name:NEW FRIENDS ADULT DAY CARE/DAY HEALTH, INC
Entity Type:Organization
Organization Name:NEW FRIENDS ADULT DAY CARE/DAY HEALTH, INC
Other - Org Name:NEW FRIENDS ADULT DAY CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-531-7663
Mailing Address - Street 1:3401 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6228
Mailing Address - Country:US
Mailing Address - Phone:704-531-7663
Mailing Address - Fax:704-531-5527
Practice Address - Street 1:3401 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6228
Practice Address - Country:US
Practice Address - Phone:704-531-7663
Practice Address - Fax:704-531-5527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408762Medicaid