Provider Demographics
NPI:1760668198
Name:RESIDENTIAL LOVING CARE GROUP HOME
Entity Type:Organization
Organization Name:RESIDENTIAL LOVING CARE GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-539-1010
Mailing Address - Street 1:PO BOX 681
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27897-0681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2924 BRYANTOWN ROAD
Practice Address - Street 2:105 WEST MAIN STREET, AHOSKIE, NC 27910
Practice Address - City:JACKSON
Practice Address - State:NC
Practice Address - Zip Code:27845-0000
Practice Address - Country:US
Practice Address - Phone:252-539-1010
Practice Address - Fax:252-539-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities