Provider Demographics
NPI:1790399301
Name:BURRIS FAMILY PAYING IT FORWARD HOMECARE LLC
Entity Type:Organization
Organization Name:BURRIS FAMILY PAYING IT FORWARD HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CNA
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:980-483-8314
Mailing Address - Street 1:PO BOX 1754
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-1754
Mailing Address - Country:US
Mailing Address - Phone:980-483-8314
Mailing Address - Fax:
Practice Address - Street 1:413 N PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-2440
Practice Address - Country:US
Practice Address - Phone:704-750-7080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service