Provider Demographics
NPI:1720218217
Name:LAWSOMS FAMILY CARE HOME#2
Entity Type:Organization
Organization Name:LAWSOMS FAMILY CARE HOME#2
Other - Org Name:LAWSON FAMILY CARE HOME#2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KEESEE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-613-5065
Mailing Address - Street 1:505 STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-3034
Mailing Address - Country:US
Mailing Address - Phone:336-342-1388
Mailing Address - Fax:336-349-4531
Practice Address - Street 1:704 WILLOW ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-3043
Practice Address - Country:US
Practice Address - Phone:336-342-9825
Practice Address - Fax:336-361-3194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL079076310400000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility