Provider Demographics
NPI:1710326079
Name:MCDANIEL HOMES,LLC
Entity Type:Organization
Organization Name:MCDANIEL HOMES,LLC
Other - Org Name:MCDANIEL HOME # 1, # 2, # 3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:DAVIS-
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-599-5473
Mailing Address - Street 1:192 COUNTRY CLUB RD # 27574
Mailing Address - Street 2:P O BOX 1636 27573
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27574-7448
Mailing Address - Country:US
Mailing Address - Phone:336-599-5473
Mailing Address - Fax:336-599-8186
Practice Address - Street 1:192 COUNTRY CLUB RD # 27574
Practice Address - Street 2:4694 CHUB LAKE RD
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27574-7448
Practice Address - Country:US
Practice Address - Phone:336-599-5473
Practice Address - Fax:336-599-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 385HR2060X
NCMHL 073-061311ZA0620X
NCMHL-073-061320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child