Provider Demographics
NPI:1487838975
Name:DAISY C. PALMS ADULT CARE, INC
Entity Type:Organization
Organization Name:DAISY C. PALMS ADULT CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PALMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-485-6610
Mailing Address - Street 1:1715 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-1425
Mailing Address - Country:US
Mailing Address - Phone:910-485-6610
Mailing Address - Fax:
Practice Address - Street 1:1715 STRATFORD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1425
Practice Address - Country:US
Practice Address - Phone:910-485-6610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL026044261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804849Medicaid