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Organization

ELLISON'S FAMILY CARE HOME3

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. CLARISSA B ELLISON (ADMINISTRATOR)
(336) 349-2220
Entity
Organization

Contact information

Practice address
31 ALEX POTEAT RD, REIDSVILLE, NC 27320-9741
(336) 634-1332
(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-017-029
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7803270
NC
Enumeration date
04/16/2007
Last updated
08/22/2020
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