ANT MARY'S FAMILY CARE HOME #3
Adult Care Home
La Grange, North Carolina
Provider NPI: 1023298718
Organization Information:Organization Name: ANT MARY'S FAMILY CARE HOME #3
Practice Location:
3713 ED HERRING RD LA GRANGE, NC 28551 US
Tel: 252-566-3700 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
3713 ED HERRING RD LA GRANGE, NC 28551 US
Tel: 252-566-3700 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 311ZA0620X | Nursing & Custodial Care Facilities Custodial Care Facility Adult Care Home | NC | FCL054059 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
FCL054059 | NC | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin