Provider Demographics
NPI:1578849386
Name:TAYLOR FAMILY CARE HOME, LLC
Entity Type:Organization
Organization Name:TAYLOR FAMILY CARE HOME, LLC
Other - Org Name:CLARA'S COTTAGE #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-674-6364
Mailing Address - Street 1:5820 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-7931
Mailing Address - Country:US
Mailing Address - Phone:828-391-1929
Mailing Address - Fax:828-391-1929
Practice Address - Street 1:5820 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-7931
Practice Address - Country:US
Practice Address - Phone:828-391-1929
Practice Address - Fax:828-391-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL012038311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home