Provider Demographics
NPI:1932705225
Name:KERNODLES FAMILY CARE NO-1
Entity Type:Organization
Organization Name:KERNODLES FAMILY CARE NO-1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:COKY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KERNODLE
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:336-327-9438
Mailing Address - Street 1:244 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:STONEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27048-7551
Mailing Address - Country:US
Mailing Address - Phone:336-327-9438
Mailing Address - Fax:
Practice Address - Street 1:311 CHERRY ST
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5637
Practice Address - Country:US
Practice Address - Phone:336-627-3243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility