Provider Demographics
NPI:1558598979
Name:CHERRY'S FAMILY CARE HOME #2
Entity Type:Organization
Organization Name:CHERRY'S FAMILY CARE HOME #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-794-2269
Mailing Address - Street 1:743 CHARLES TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:AULANDER
Mailing Address - State:NC
Mailing Address - Zip Code:27805-9690
Mailing Address - Country:US
Mailing Address - Phone:252-794-2269
Mailing Address - Fax:252-345-1338
Practice Address - Street 1:743 CHARLES TAYLOR RD
Practice Address - Street 2:
Practice Address - City:AULANDER
Practice Address - State:NC
Practice Address - Zip Code:27805-9690
Practice Address - Country:US
Practice Address - Phone:252-794-2269
Practice Address - Fax:252-345-1338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL008023320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities