Provider Demographics
NPI:1669510905
Name:FIELDS FOUNDATION, INC.
Entity Type:Organization
Organization Name:FIELDS FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DBA
Authorized Official - Phone:252-792-6343
Mailing Address - Street 1:1895 GREEN ACRES RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-8252
Mailing Address - Country:US
Mailing Address - Phone:252-792-6343
Mailing Address - Fax:252-792-2881
Practice Address - Street 1:1895 GREEN ACRES RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-8252
Practice Address - Country:US
Practice Address - Phone:252-792-6343
Practice Address - Fax:252-792-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-058-008311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home