Provider Demographics
NPI:1902033285
Name:PERSONAL TOUCH FAMILY CARE HOME
Entity Type:Organization
Organization Name:PERSONAL TOUCH FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-422-9998
Mailing Address - Street 1:9461 HWY 710 SOUTH
Mailing Address - Street 2:
Mailing Address - City:ROWLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28383-8551
Mailing Address - Country:US
Mailing Address - Phone:910-422-9998
Mailing Address - Fax:910-422-3610
Practice Address - Street 1:9461 HWY 710 SOUTH
Practice Address - Street 2:
Practice Address - City:ROWLAND
Practice Address - State:NC
Practice Address - Zip Code:28383-8551
Practice Address - Country:US
Practice Address - Phone:910-422-9998
Practice Address - Fax:910-422-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL078047310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805533Medicaid