Provider Demographics
NPI:1790126126
Name:RAY, LAWANDA
Entity Type:Individual
Prefix:
First Name:LAWANDA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4094
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-0901
Mailing Address - Country:US
Mailing Address - Phone:336-421-0435
Mailing Address - Fax:336-584-5533
Practice Address - Street 1:625 LANE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2473
Practice Address - Country:US
Practice Address - Phone:336-229-9900
Practice Address - Fax:336-584-5533
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-14
Last Update Date:2013-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-001-149311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home