Provider Demographics
NPI:1669678355
Name:GARRISONS FAMILY CARE HOME INC
Entity Type:Organization
Organization Name:GARRISONS FAMILY CARE HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELILAH
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:919-847-5248
Mailing Address - Street 1:4333 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8134
Mailing Address - Country:US
Mailing Address - Phone:919-847-5248
Mailing Address - Fax:919-847-5248
Practice Address - Street 1:4333 DURHAM RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8134
Practice Address - Country:US
Practice Address - Phone:919-847-5248
Practice Address - Fax:919-847-5248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL092517320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804710Medicaid