Provider Demographics
NPI:1356672117
Name:DIAL'S FAMILY CARE HOME #2
Entity Type:Organization
Organization Name:DIAL'S FAMILY CARE HOME #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUJAHED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-318-9667
Mailing Address - Street 1:1685 CANAL RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-9343
Mailing Address - Country:US
Mailing Address - Phone:910-318-9667
Mailing Address - Fax:910-522-7327
Practice Address - Street 1:1685 CANAL RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-9343
Practice Address - Country:US
Practice Address - Phone:910-318-9667
Practice Address - Fax:910-522-7327
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAL'S FAMILY CARE HOME INCORPORATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-078-075311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home