Provider Demographics
NPI:1811011802
Name:CHEETHAM FAMILY CARE HOME
Entity Type:Organization
Organization Name:CHEETHAM FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANSFORD
Authorized Official - Middle Name:NYLANDER
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-795-8338
Mailing Address - Street 1:5309 FALLS OF NEUSE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4700
Mailing Address - Country:US
Mailing Address - Phone:919-676-8062
Mailing Address - Fax:919-676-8062
Practice Address - Street 1:2726 NEWSOME ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-2956
Practice Address - Country:US
Practice Address - Phone:919-325-0671
Practice Address - Fax:919-325-0671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092-538-27G.56003104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804824Medicaid