Provider Demographics
NPI:1649434598
Name:THE JANICE MAE HAWKINS FOUNDATION INC
Entity type:Organization
Organization Name:THE JANICE MAE HAWKINS FOUNDATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:910-864-3426
Mailing Address - Street 1:204 S REILLY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-0340
Mailing Address - Country:US
Mailing Address - Phone:910-864-3426
Mailing Address - Fax:910-764-1457
Practice Address - Street 1:204 S REILLY RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0340
Practice Address - Country:US
Practice Address - Phone:910-864-3426
Practice Address - Fax:910-764-1457
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S & S ASSOCIATES HOME HEALTH CARE AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2410314000000X, 311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601181Medicaid