Provider Demographics
NPI:1801081310
Name:LEE'S FAMILY CARE HOME
Entity type:Organization
Organization Name:LEE'S FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-853-3359
Mailing Address - Street 1:945 VAIDEN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-8096
Mailing Address - Country:US
Mailing Address - Phone:919-853-3359
Mailing Address - Fax:919-853-3359
Practice Address - Street 1:945 VAIDEN ROAD
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-8096
Practice Address - Country:US
Practice Address - Phone:919-853-3359
Practice Address - Fax:919-853-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL035-002177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC900-47-3245-0Medicaid
NC900-85-1645-0Medicaid
NC945-00-6722-SMedicaid
NC947-58-7594-SMedicaid