Provider Demographics
NPI:1619658341
Name:LIBBY J BLACKWELL
Entity Type:Organization
Organization Name:LIBBY J BLACKWELL
Other - Org Name:LIBBY'S FAMILY CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LIBBY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-278-4111
Mailing Address - Street 1:4035 WOODLEAF BARBER RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:NC
Mailing Address - Zip Code:27013-9140
Mailing Address - Country:US
Mailing Address - Phone:704-278-4111
Mailing Address - Fax:704-278-4111
Practice Address - Street 1:4035 WOODLEAF BARBER RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:NC
Practice Address - Zip Code:27013-9140
Practice Address - Country:US
Practice Address - Phone:704-278-4111
Practice Address - Fax:704-278-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home