Provider Demographics
NPI: | 1639355514 |
---|---|
Name: | BARNES FAMILY CARE HOME, INC |
Entity Type: | Organization |
Organization Name: | BARNES FAMILY CARE HOME, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | CARRIE |
Authorized Official - Middle Name: | BARNES |
Authorized Official - Last Name: | DUDLEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 252-286-6854 |
Mailing Address - Street 1: | PO BOX 2503 |
Mailing Address - Street 2: | |
Mailing Address - City: | KINSTON |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28502-2503 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 252-286-6854 |
Mailing Address - Fax: | 252-522-5941 |
Practice Address - Street 1: | 1106 E CASWELL ST |
Practice Address - Street 2: | |
Practice Address - City: | KINSTON |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28501-5308 |
Practice Address - Country: | US |
Practice Address - Phone: | 252-522-2634 |
Practice Address - Fax: | 252-522-5941 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-01-10 |
Last Update Date: | 2008-01-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | FCL-054-061 | 310400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility |