Provider Demographics
NPI:1538289962
Name:LUCAMA FAMILY CARE HOME
Entity Type:Organization
Organization Name:LUCAMA FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:P
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-239-0212
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:LUCAMA
Mailing Address - State:NC
Mailing Address - Zip Code:27851-0012
Mailing Address - Country:US
Mailing Address - Phone:252-239-0212
Mailing Address - Fax:252-239-0312
Practice Address - Street 1:302 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUCAMA
Practice Address - State:NC
Practice Address - Zip Code:27851-0012
Practice Address - Country:US
Practice Address - Phone:252-239-0212
Practice Address - Fax:252-239-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility