Provider Demographics
NPI:1710671441
Name:LOR-CROWE FAMILY CARE HOME
Entity Type:Organization
Organization Name:LOR-CROWE FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TIJUANA
Authorized Official - Middle Name:DELROYA
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-528-7921
Mailing Address - Street 1:210 HEATHER RIDGE DR APT J
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7037
Mailing Address - Country:US
Mailing Address - Phone:910-491-3069
Mailing Address - Fax:910-504-0155
Practice Address - Street 1:814 E SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-4544
Practice Address - Country:US
Practice Address - Phone:910-491-3069
Practice Address - Fax:910-504-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home