# CAROL LEE FAMILY CARE HOME

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952423394
- **Authorized official:** MRS. JOAN CONVERSE (OWNER)
- **Authorized official phone:** (336) 622-3002

## Contact information

- **Practice address:** 319 E RALEIGH AVE, LIBERTY, NC 27298-3304
- **Practice address phone:** (336) 622-3002
- **Mailing address:** 319 E RALEIGH AVE, LIBERTY, NC 27298-3304
- **Mailing address phone:** (336) 622-3002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | FCL-076-021 | NC | Yes |

## Other

- **Enumeration date:** 04/05/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7803999 | — | NC |