Provider Demographics
NPI:1295504058
Name:THE WHITE HOUSE FAMILY CARE HOME, LLC
Entity type:Organization
Organization Name:THE WHITE HOUSE FAMILY CARE HOME, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-286-2713
Mailing Address - Street 1:306 CHERRY GRV
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-3006
Mailing Address - Country:US
Mailing Address - Phone:980-286-2713
Mailing Address - Fax:919-294-6164
Practice Address - Street 1:306 CHERRY GRV
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-3006
Practice Address - Country:US
Practice Address - Phone:980-286-2713
Practice Address - Fax:919-294-6164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home