Provider Demographics
NPI:1568584050
Name:C.L. FAMILY CARE HOME
Entity Type:Organization
Organization Name:C.L. FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-356-2260
Mailing Address - Street 1:622 CULLEN RD
Mailing Address - Street 2:
Mailing Address - City:HARRELLSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27942-9766
Mailing Address - Country:US
Mailing Address - Phone:252-356-2260
Mailing Address - Fax:252-356-2260
Practice Address - Street 1:622 CULLEN RD
Practice Address - Street 2:
Practice Address - City:HARRELLSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27942-9766
Practice Address - Country:US
Practice Address - Phone:252-356-2260
Practice Address - Fax:252-356-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-046-017261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805116Medicaid