Organization
A GOOD LIFE FAMILY CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE COLE BALLENTINE (OWNER/ADMINISTRATOR)
(919) 834-3966
Entity
Organization
Contact information
Practice address
4013 TRYON RD, RALEIGH, NC 27606-4209
(919) 834-3966
(919) 834-3966
Mailing address
4013 TRYON RD, RALEIGH, NC 27606-4209
(919) 834-3966
(919) 834-3966
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
FCL-092-106
NC
Other
Enumeration date
04/22/2009
Last updated
04/22/2009
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