Provider Demographics
NPI:1629151097
Name:PARKERS FAMILY CARE HOME
Entity Type:Organization
Organization Name:PARKERS FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALFREDA
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:CETIFIED
Authorized Official - Phone:336-538-2867
Mailing Address - Street 1:10123 WADES DEAD END RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:27231-9026
Mailing Address - Country:US
Mailing Address - Phone:336-562-3203
Mailing Address - Fax:
Practice Address - Street 1:502 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-9271
Practice Address - Country:US
Practice Address - Phone:336-538-2867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-22
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-017-012311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home