Provider Demographics
NPI:1790979193
Name:LISA PETTIFORD
Entity Type:Organization
Organization Name:LISA PETTIFORD
Other - Org Name:CARE HEALTH SERVICES#2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:PETTIFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-599-3691
Mailing Address - Street 1:PO BOX 15335
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-0335
Mailing Address - Country:US
Mailing Address - Phone:919-599-3691
Mailing Address - Fax:919-493-2112
Practice Address - Street 1:502 HUGO STREET
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-0335
Practice Address - Country:US
Practice Address - Phone:919-599-3691
Practice Address - Fax:919-493-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC032-406311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home