Provider Demographics
NPI:1750587333
Name:WATLINGTON'S FAMILY CARE
Entity type:Organization
Organization Name:WATLINGTON'S FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMULUS
Authorized Official - Middle Name:THURMAN
Authorized Official - Last Name:WATLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-254-9662
Mailing Address - Street 1:2014 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-3832
Mailing Address - Country:US
Mailing Address - Phone:336-254-9662
Mailing Address - Fax:336-274-1938
Practice Address - Street 1:2014 WILLOW RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-3832
Practice Address - Country:US
Practice Address - Phone:336-254-9662
Practice Address - Fax:336-274-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFLC-041-034311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802911Medicaid