Provider Demographics
NPI:1720275423
Name:EASTLAND HOME, INC
Entity Type:Organization
Organization Name:EASTLAND HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:MURPHY
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-862-2696
Mailing Address - Street 1:2137 SPRING BRANCH RD
Mailing Address - Street 2:PO BOX 152
Mailing Address - City:TAR HEEL
Mailing Address - State:NC
Mailing Address - Zip Code:28392
Mailing Address - Country:US
Mailing Address - Phone:910-862-2696
Mailing Address - Fax:910-862-2696
Practice Address - Street 1:2137 SPRING BRANCH RD.
Practice Address - Street 2:
Practice Address - City:TAR HEEL
Practice Address - State:NC
Practice Address - Zip Code:28392
Practice Address - Country:US
Practice Address - Phone:910-862-2696
Practice Address - Fax:910-862-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-009-004311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home