# MAE CORBETT CONNALLY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Corbett's FCH-Two
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407976889
- **Authorized official:** MRS. MAE CORBETT CONNALLY (WONER)
- **Authorized official phone:** (336) 234-7502

## Contact information

- **Practice address:** 362 HUDSON RD, MILTON, NC 27305-9680
- **Practice address phone:** (336) 234-7502
- **Mailing address:** 203 N MAIN ST, SUITE 315, ROXBORO, NC 27573-5343
- **Mailing address phone:** (336) 234-7502

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | FCL017004 | NC | Yes |

## Other

- **Enumeration date:** 03/30/2007
- **Last updated:** 06/19/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7802647 | — | NC |