Provider Demographics
NPI:1528188232
Name:C&W ALTERNATIVE FAMILY LIVING FACILITY, INC.
Entity Type:Organization
Organization Name:C&W ALTERNATIVE FAMILY LIVING FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, QP
Authorized Official - Phone:336-723-3829
Mailing Address - Street 1:3365 NEW WALKERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-4160
Mailing Address - Country:US
Mailing Address - Phone:336-723-3829
Mailing Address - Fax:336-723-3829
Practice Address - Street 1:3365 NEW WALKERTOWN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-4160
Practice Address - Country:US
Practice Address - Phone:336-723-3829
Practice Address - Fax:336-723-3829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL- 034-160310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301339Medicaid