Provider Demographics
NPI:1831484385
Name:ELSIE-DORIS FAMILY CARE HOME II
Entity Type:Organization
Organization Name:ELSIE-DORIS FAMILY CARE HOME II
Other - Org Name:ELSIE-DORIS FAMILY CARE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAQUITA
Authorized Official - Middle Name:TAMECIA
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-225-5046
Mailing Address - Street 1:1009 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-4407
Mailing Address - Country:US
Mailing Address - Phone:919-225-5046
Mailing Address - Fax:919-680-2730
Practice Address - Street 1:1009 S ALSTON AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-4407
Practice Address - Country:US
Practice Address - Phone:919-225-5046
Practice Address - Fax:919-680-2730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC032-108311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home