Organization
LISA PETTIFORD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA SPENCER PETTIFORD (OWNER)
(919) 599-3691
Entity
Organization
Contact information
Practice address
2801 DARROW RD., DURHAM, NC 27704-0335
(919) 493-2100
(919) 493-2112
Mailing address
PO BOX 15535, DURHAM, NC 27704-0535
(919) 493-2100
(919) 493-2112
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
032-407
NC
Other
Enumeration date
09/11/2007
Last updated
07/10/2008
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