Organization
LUCORJA FAMILY CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CORLISS L COOKE (PRESIDENT)
(704) 563-1020
Entity
Organization
Contact information
Practice address
5356 COBURG AVE, CHARLOTTE, NC 28215-2202
(704) 563-1020
(704) 563-1072
Mailing address
4701 FREEDOM DR, CHARLOTTE, NC 28208-1719
(704) 398-9574
(704) 392-5524
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
FCI060069
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805039
—
NC
Enumeration date
11/02/2006
Last updated
08/21/2007
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