Provider Demographics
NPI:1154528222
Name:NANAS TOUCH FAMILY CARE HOME
Entity type:Organization
Organization Name:NANAS TOUCH FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MBURU
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:919-754-0529
Mailing Address - Street 1:2604 ADCOX PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5802
Mailing Address - Country:US
Mailing Address - Phone:919-673-7717
Mailing Address - Fax:919-754-0529
Practice Address - Street 1:2604 ADCOX PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-5802
Practice Address - Country:US
Practice Address - Phone:919-673-7717
Practice Address - Fax:919-754-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-01
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCH092129311Z00000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility