Provider Demographics
NPI:1790064558
Name:CHILTON FAMILY CARE HOME, LLC
Entity Type:Organization
Organization Name:CHILTON FAMILY CARE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHILTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:336-552-3030
Mailing Address - Street 1:135 TURNER FARM LN
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-7288
Mailing Address - Country:US
Mailing Address - Phone:336-634-1631
Mailing Address - Fax:336-342-4458
Practice Address - Street 1:135 TURNER FARM LN
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-7288
Practice Address - Country:US
Practice Address - Phone:336-634-1631
Practice Address - Fax:336-342-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-079-085311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home