Provider Demographics
NPI:1720262223
Name:MAYFLOWER SENIOR CARE, INC
Entity Type:Organization
Organization Name:MAYFLOWER SENIOR CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVET
Authorized Official - Middle Name:R
Authorized Official - Last Name:TRANTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-645-5284
Mailing Address - Street 1:48 ROBERTS COVE RD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9748
Mailing Address - Country:US
Mailing Address - Phone:828-645-5284
Mailing Address - Fax:
Practice Address - Street 1:48 ROBERTS COVE RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9748
Practice Address - Country:US
Practice Address - Phone:828-645-5284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCH011187261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805139Medicaid