Provider Demographics
NPI:1295850519
Name:FAMILY AFFAIR CARE GROUP MANAGEMENT, INC
Entity type:Organization
Organization Name:FAMILY AFFAIR CARE GROUP MANAGEMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-274-1269
Mailing Address - Street 1:2302 W MEADOWVIEW RD STE 208
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3706
Mailing Address - Country:US
Mailing Address - Phone:336-274-1269
Mailing Address - Fax:336-272-2387
Practice Address - Street 1:2302 W MEADOWVIEW RD STE 208
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3706
Practice Address - Country:US
Practice Address - Phone:336-274-1269
Practice Address - Fax:336-272-2387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408898Medicaid