Organization
MT. OLIVE FAMILY CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIE EDWARD SPRUILL (ADMINISTRATOR)
(910) 628-7755
Entity
Organization
Contact information
Practice address
2583 RED STORE RD, WHITEVILLE, NC 28472-6831
(910) 648-4946
Mailing address
305 JACKSON ST, FAIRMONT, NC 28340-1621
(910) 628-7755
(910) 628-7755
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
FCL-024-002
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7801519
—
NC
Enumeration date
03/01/2007
Last updated
08/22/2020
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