Provider Demographics
NPI:1801923099
Name:NARU FAMILY CARE HOMES#2
Entity type:Organization
Organization Name:NARU FAMILY CARE HOMES#2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-972-1892
Mailing Address - Street 1:PO BOX 1101
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-1101
Mailing Address - Country:US
Mailing Address - Phone:336-776-1870
Mailing Address - Fax:
Practice Address - Street 1:4266 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-2510
Practice Address - Country:US
Practice Address - Phone:336-776-1870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NARU FAMILY CARE HOMES#1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL034072261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service