Provider Demographics
NPI:1003012220
Name:MAGGIE'S FAMILY CARE HOME INC.
Entity type:Organization
Organization Name:MAGGIE'S FAMILY CARE HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SISK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-833-7294
Mailing Address - Street 1:213 QUEENS RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-6737
Mailing Address - Country:US
Mailing Address - Phone:704-833-7294
Mailing Address - Fax:704-867-4716
Practice Address - Street 1:213 QUEENS RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-6737
Practice Address - Country:US
Practice Address - Phone:704-833-7294
Practice Address - Fax:704-867-4716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-036-021310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility