ANT MARY'S FAMILY CARE HOME #3 NPI 1023298718

Custodial Care Facility (Adult Care Home) in La Grange, NC

NPI 1023298718 Organization Custodial Care Facility Adult Care Home

About ANT MARY'S FAMILY CARE HOME #3

Ant Mary's Family Care Home #3 is a provider established in La Grange, North Carolina specializing in custodial care facility (adult care home) . The NPI number of Ant Mary's Family Care Home #3 is 1023298718 and was assigned on November 2007. The practitioner's primary taxonomy code is 311ZA0620X with license number FCL054059 (NC). The provider is registered as an organization and their NPI record was last updated 14 years ago. The authorized official of this NPI record is Eula Britt (Owner)

NPI

1023298718

Provider NameANT MARY'S FAMILY CARE HOME #3
Provider Location Address3713 ED HERRING RD LA GRANGE, NC 28551
Provider Mailing AddressPO BOX 516 LA GRANGE, NC 28551
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date11-09-2007
Last Update Date11-09-2007


Primary Taxonomy

Taxonomy Code311ZA0620X
ClassificationCustodial Care Facility
TypeNursing & Custodial Care Facilities
SpecializationAdult Care Home
License No.FCL054059
License StateNC
Taxonomy DescriptionA custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.

Business Address

ANT MARY'S FAMILY CARE HOME #3
3713 ED HERRING RD
LA GRANGE, NC
ZIP 28551
Phone: (252) 566-3700
Fax: (252) 566-3598

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Mailing Address

ANT MARY'S FAMILY CARE HOME #3
PO BOX 516
LA GRANGE, NC
ZIP 28551
Phone:



Authorized Official

Authorized Official Name EULA BRITT
Authorized Official TitleOWNER
Authorized Official Phone(252) 566-5998

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
FCL054059MEDICAID (05)NC

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.