Organization
ELLISON'S FAMILY CARE HOME #2
Active
Organization
ELLISON'S FAMILY CARE HOME #2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CLARISSA B ELLISON (ADMINISTRATOR)
(336) 349-2220
Entity
Organization
Contact information
Practice address
1116 LAWSONVILLE AVE, REIDSVILLE, NC 27320-4112
(336) 634-0004
(336) 349-2273
Mailing address
PO BOX 1316, REIDSVILLE, NC 27323-1316
(336) 349-2220
(336) 349-2273
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
FCL-079-040
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7803261
—
NC
Enumeration date
04/16/2007
Last updated
08/22/2020
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