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Organization

FAMILY HOME LIFE, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DEBORAH GRAY TANNER (DIRECTOR OWNER)
(252) 533-9200
Entity
Organization

Contact information

Practice address
544 JULIAN R ALLSBROOK HWY, ROANOKE RAPIDS, NC 27870-4611
(252) 533-9200
Mailing address
PO BOX 66, ROANOKE RAPIDS, NC 27870-0066
(252) 533-9200

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
251B00000X
Case Management Agency
251S00000X
Community/Behavioral Health Agency
Primary
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL042038
NC
385H00000X
Respite Care
MHL042038
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8300261
NC
Enumeration date
07/16/2006
Last updated
04/09/2008
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