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Organization
MAYOS LOVING CARE ADULT GROUP HOME
Active
Organization
MAYOS LOVING CARE ADULT GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL CORMELIUS MAYO SR. LRT/CTRS (QP/CO-OWNER)
(252) 281-7717
Entity
Organization
Contact information
Practice address
105 KRISTA LN, ROCKY MOUNT, NC 27803-5228
(252) 973-8593
(252) 407-4950
Mailing address
105 KRISTA LN, ROCKY MOUNT, NC 27803-5228
(252) 973-8593
(252) 407-4950
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
MHL064115
NC
347C00000X
Private Vehicle
MHL064115
NC
Other
Enumeration date
07/14/2010
Last updated
07/14/2010
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