Provider Demographics
NPI:1558618504
Name:UNLIMITED POSSIBILITIES FAMILY CARE HOME #3, LLC
Entity Type:Organization
Organization Name:UNLIMITED POSSIBILITIES FAMILY CARE HOME #3, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRUGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-249-7718
Mailing Address - Street 1:14009 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-1516
Mailing Address - Country:US
Mailing Address - Phone:704-443-7049
Mailing Address - Fax:980-224-7056
Practice Address - Street 1:338 S SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2806
Practice Address - Country:US
Practice Address - Phone:704-453-6753
Practice Address - Fax:704-353-7927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-060-122310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility