Provider Demographics
NPI:1467576819
Name:CHERRYS FAMILY CARE #3
Entity Type:Organization
Organization Name:CHERRYS FAMILY CARE #3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-345-1338
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:AULANDER
Mailing Address - State:NC
Mailing Address - Zip Code:27805-0236
Mailing Address - Country:US
Mailing Address - Phone:252-345-1338
Mailing Address - Fax:252-345-1338
Practice Address - Street 1:106 HARMON STREET
Practice Address - Street 2:
Practice Address - City:AULANDER
Practice Address - State:NC
Practice Address - Zip Code:27805-0236
Practice Address - Country:US
Practice Address - Phone:252-345-1310
Practice Address - Fax:252-345-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL008008311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801412Medicaid