Provider Demographics
NPI:1124288964
Name:SCHENCK FAMILY CARE HOME
Entity type:Organization
Organization Name:SCHENCK FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:SCHENCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-735-6565
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:IRON STATION
Mailing Address - State:NC
Mailing Address - Zip Code:28080-0041
Mailing Address - Country:US
Mailing Address - Phone:704-735-6565
Mailing Address - Fax:
Practice Address - Street 1:4823 PAYSOUR POND RD
Practice Address - Street 2:
Practice Address - City:IRON STATION
Practice Address - State:NC
Practice Address - Zip Code:28080-0041
Practice Address - Country:US
Practice Address - Phone:704-735-6565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL055001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802751Medicaid