Provider Demographics
NPI:1922275775
Name:GWENS FAMILY CARE HOME 2
Entity Type:Organization
Organization Name:GWENS FAMILY CARE HOME 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:SHOFFNER
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-622-1842
Mailing Address - Street 1:236 S ASHEBORO ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:27298-7503
Mailing Address - Country:US
Mailing Address - Phone:336-622-1842
Mailing Address - Fax:
Practice Address - Street 1:7964 COUNTY LINE RD
Practice Address - Street 2:A
Practice Address - City:LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:27298-9590
Practice Address - Country:US
Practice Address - Phone:336-622-1842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health