Provider Demographics
NPI:1336279629
Name:BEVERLY RUCKER FAMILY CARE HOME #7
Entity Type:Organization
Organization Name:BEVERLY RUCKER FAMILY CARE HOME #7
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:LAWSON
Authorized Official - Last Name:RUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-613-1552
Mailing Address - Street 1:1123 CRUTCHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-8954
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:336-349-2873
Practice Address - Street 1:6878 NC 150
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-0269
Practice Address - Country:US
Practice Address - Phone:336-613-1552
Practice Address - Fax:336-349-2873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility