Provider Demographics
NPI:1972706232
Name:LUCY NANNIE HAIRSTON
Entity Type:Organization
Organization Name:LUCY NANNIE HAIRSTON
Other - Org Name:L & L FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-939-7176
Mailing Address - Street 1:3023 CHANDLER MILL RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27311-8785
Mailing Address - Country:US
Mailing Address - Phone:336-939-7176
Mailing Address - Fax:
Practice Address - Street 1:3023 CHANDLER MILL RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NC
Practice Address - Zip Code:27311-8785
Practice Address - Country:US
Practice Address - Phone:336-939-7176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-017-026311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803034Medicaid