Provider Demographics
NPI:1780803270
Name:DAPHNE'S FAMILY CARE HOME
Entity type:Organization
Organization Name:DAPHNE'S FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-342-4040
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27323-1027
Mailing Address - Country:US
Mailing Address - Phone:336-342-4040
Mailing Address - Fax:336-342-4999
Practice Address - Street 1:1802 AMOS ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-6204
Practice Address - Country:US
Practice Address - Phone:336-342-4040
Practice Address - Fax:336-342-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-079-024311ZA0620X
NCFCL-079-029311ZA0620X
NCFCL-079-025311ZA0620X
NCFCL-079-038311ZA0620X
NCFCL-079-047311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803345Medicaid
NC7803346Medicaid
NC7803358Medicaid
NC7804199Medicaid
NC7801517Medicaid