Provider Demographics
NPI:1780847780
Name:DOGWOOD FAMILY CARE HOME
Entity type:Organization
Organization Name:DOGWOOD FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR IN CHARGE
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERLYN
Authorized Official - Middle Name:LASHUNDA
Authorized Official - Last Name:CASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-436-0046
Mailing Address - Street 1:840 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-1651
Mailing Address - Country:US
Mailing Address - Phone:336-436-0046
Mailing Address - Fax:336-436-0069
Practice Address - Street 1:840 ROSS ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-1651
Practice Address - Country:US
Practice Address - Phone:336-436-0046
Practice Address - Fax:336-436-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC052168Medicaid