Provider Demographics
NPI:1619202710
Name:UNLIMITED POSSIBILITIES FAMILY HOME CARE
Entity Type:Organization
Organization Name:UNLIMITED POSSIBILITIES FAMILY HOME CARE
Other - Org Name:UNLIMITED POSSIBILITIES FAMILY CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:SCRUGGS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-453-6753
Mailing Address - Street 1:5226 ADDISON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4135
Mailing Address - Country:US
Mailing Address - Phone:704-453-6753
Mailing Address - Fax:704-749-9522
Practice Address - Street 1:5003 TEWKESBURY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-4557
Practice Address - Country:US
Practice Address - Phone:704-453-6753
Practice Address - Fax:704-749-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL000100311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home