Provider Demographics
NPI:1942353321
Name:FAMILY AFFAIR CARE GROUP MANAGEMENT INC
Entity Type:Organization
Organization Name:FAMILY AFFAIR CARE GROUP MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-274-1269
Mailing Address - Street 1:1012 GREGORY ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-3029
Mailing Address - Country:US
Mailing Address - Phone:336-856-7991
Mailing Address - Fax:336-856-7994
Practice Address - Street 1:6113 BLUE LANTERN RD
Practice Address - Street 2:
Practice Address - City:GIBSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27249-8737
Practice Address - Country:US
Practice Address - Phone:336-443-5690
Practice Address - Fax:336-449-5690
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY AFFAIR CARE GROUP MANAGEMENT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3406564315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities