Organization
SMALL FAMILY CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. IRENE SMALL (OWNER)
(252) 492-2316
Entity
Organization
Contact information
Practice address
1421 ROSS MILL RD, HENDERSON, NC 27537-5965
(252) 492-2316
Mailing address
1421 ROSS MILL RD, HENDERSON, NC 27537-5965
(252) 492-2316
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
FCH091008
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7803224
—
NC
Enumeration date
12/20/2007
Last updated
12/20/2007
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