Provider Demographics
NPI:1891201042
Name:LITTLE FAMILY CARE HOME, LLC
Entity Type:Organization
Organization Name:LITTLE FAMILY CARE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:TONDRA
Authorized Official - Middle Name:ANJANETTE
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-227-2543
Mailing Address - Street 1:PO BOX 16014
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1014
Mailing Address - Country:US
Mailing Address - Phone:984-227-2543
Mailing Address - Fax:984-219-6264
Practice Address - Street 1:1012 DAVINCI STREET
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704
Practice Address - Country:US
Practice Address - Phone:984-227-2543
Practice Address - Fax:984-219-6264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-032459311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1033625702Medicaid