Provider Demographics
NPI:1861511073
Name:EMMANUEL FAMILY CARE II,LLC
Entity Type:Organization
Organization Name:EMMANUEL FAMILY CARE II,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:ROBINSON
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-585-2025
Mailing Address - Street 1:2655 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8829
Mailing Address - Country:US
Mailing Address - Phone:336-585-2025
Mailing Address - Fax:336-584-5037
Practice Address - Street 1:2655 WHITE OAK DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8829
Practice Address - Country:US
Practice Address - Phone:336-585-2025
Practice Address - Fax:336-584-5037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-001-102311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805364Medicaid