Provider Demographics
NPI:1629137484
Name:SAVANNAH FAMILY CARE HOME
Entity Type:Organization
Organization Name:SAVANNAH FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARRONDA
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:SAVANNAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-695-3665
Mailing Address - Street 1:128 N CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-3938
Mailing Address - Country:US
Mailing Address - Phone:910-695-3665
Mailing Address - Fax:910-695-3665
Practice Address - Street 1:128 N CARLISLE ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-3938
Practice Address - Country:US
Practice Address - Phone:910-695-3665
Practice Address - Fax:910-695-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC063009311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home