Provider Demographics
NPI:1376755215
Name:DIAL'S FAMILY CARE HOME #9
Entity Type:Organization
Organization Name:DIAL'S FAMILY CARE HOME #9
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-522-7327
Mailing Address - Street 1:PO BOX 4134
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:910-522-7327
Mailing Address - Fax:910-521-1197
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:910-522-7327
Practice Address - Fax:910-521-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-078-0263104A0625X
NCFCL-078-112311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1376755215Medicaid