Provider Demographics
NPI:1205976347
Name:WATLINGTON FAMILY CARE
Entity type:Organization
Organization Name:WATLINGTON FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMULUS
Authorized Official - Middle Name:THURMAN
Authorized Official - Last Name:WATLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:QP
Authorized Official - Phone:336-254-9662
Mailing Address - Street 1:1401 SHERROD WATLINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-9463
Mailing Address - Country:US
Mailing Address - Phone:336-254-9662
Mailing Address - Fax:336-292-3090
Practice Address - Street 1:1401 SHERROD WATLINGTON CIR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-9463
Practice Address - Country:US
Practice Address - Phone:336-254-9662
Practice Address - Fax:336-292-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-7753104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805686Medicaid
NC7802911Medicaid
NC7801734Medicaid