Provider Demographics
NPI:1760502090
Name:CLEMMIE'S FAMILY CARE HOME
Entity Type:Organization
Organization Name:CLEMMIE'S FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CLEMMIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-746-6388
Mailing Address - Street 1:4271 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513-7107
Mailing Address - Country:US
Mailing Address - Phone:252-746-6388
Mailing Address - Fax:252-746-6388
Practice Address - Street 1:4271 HIGH ST
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513-7107
Practice Address - Country:US
Practice Address - Phone:252-746-6388
Practice Address - Fax:252-746-6388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-074006310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility