Provider Demographics
NPI:1851690564
Name:FAMILY TIES ADULT CARE HOME
Entity Type:Organization
Organization Name:FAMILY TIES ADULT CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-785-4520
Mailing Address - Street 1:305 BETHPAGE RD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-4812
Mailing Address - Country:US
Mailing Address - Phone:704-785-4520
Mailing Address - Fax:704-782-0554
Practice Address - Street 1:305 BETHPAGE RD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-4812
Practice Address - Country:US
Practice Address - Phone:704-785-4520
Practice Address - Fax:704-782-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL013040261QG0250X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics