Provider Demographics
NPI:1457656100
Name:HUMPHREY FAMILY CARE HOME
Entity Type:Organization
Organization Name:HUMPHREY FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-575-5696
Mailing Address - Street 1:1156 HORSESHOE TRL
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:VA
Mailing Address - Zip Code:24520-3084
Mailing Address - Country:US
Mailing Address - Phone:434-575-5696
Mailing Address - Fax:434-575-5696
Practice Address - Street 1:6245 BURTON CHAPEL RD
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-7364
Practice Address - Country:US
Practice Address - Phone:336-421-9560
Practice Address - Fax:336-421-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home