Provider Demographics
NPI:1811261258
Name:UNITED FAMILY CARE NETWORK LLC
Entity type:Organization
Organization Name:UNITED FAMILY CARE NETWORK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-748-3033
Mailing Address - Street 1:PO BOX 15362
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-0362
Mailing Address - Country:US
Mailing Address - Phone:919-748-3033
Mailing Address - Fax:919-973-0771
Practice Address - Street 1:1230 AVONDALE DR STE 4
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2357
Practice Address - Country:US
Practice Address - Phone:919-748-3033
Practice Address - Fax:919-748-3245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3912251E00000X
251J00000X, 251S00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC MEDICAIDMedicaid