Provider Demographics
NPI:1578766481
Name:DAVIS FAMILY CARE HOME
Entity Type:Organization
Organization Name:DAVIS FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOMINICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-339-3303
Mailing Address - Street 1:408 MIMOSA ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-3535
Mailing Address - Country:US
Mailing Address - Phone:919-339-3303
Mailing Address - Fax:919-603-9644
Practice Address - Street 1:408 MIMOSA ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-3535
Practice Address - Country:US
Practice Address - Phone:919-339-3303
Practice Address - Fax:919-603-9644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility