Provider Demographics
NPI:1780008177
Name:LINWOODS FAMILY CARE HOME
Entity Type:Organization
Organization Name:LINWOODS FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LACOLD
Authorized Official - Middle Name:LATRESE
Authorized Official - Last Name:PRIDGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-789-1937
Mailing Address - Street 1:7801 SLOCUM TRL
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NC
Mailing Address - Zip Code:28421-9323
Mailing Address - Country:US
Mailing Address - Phone:910-283-7361
Mailing Address - Fax:
Practice Address - Street 1:7801 SLOCUM TRL
Practice Address - Street 2:
Practice Address - City:ATKINSON
Practice Address - State:NC
Practice Address - Zip Code:28421-9323
Practice Address - Country:US
Practice Address - Phone:910-283-7361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness