Provider Demographics
NPI:1598775165
Name:BAINBRIDGE FAMILY CARE HOME, INC.
Entity Type:Organization
Organization Name:BAINBRIDGE FAMILY CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:GILLIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:AKABI-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-661-0289
Mailing Address - Street 1:202 BAINBRIDGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529
Mailing Address - Country:US
Mailing Address - Phone:919-661-0289
Mailing Address - Fax:919-662-7683
Practice Address - Street 1:202 BAINBRIDGE CIRCLE
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529
Practice Address - Country:US
Practice Address - Phone:919-661-0289
Practice Address - Fax:919-662-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-092-059311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803251OtherPROVIDER NUMBER