Organization
WILLIE N DIXON
Active
Organization
WILLIE N DIXON
Active
Other names
Shepherd Grove Family Care II
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIE N DIXON (OWNER)
(252) 243-9827
Entity
Organization
Contact information
Practice address
2507 CANAL DR NW, WILSON, NC 27896-1325
(252) 291-7043
(252) 291-9448
Mailing address
2507 CANAL DR NW, WILSON, NC 27896-1325
(252) 291-7043
(252) 291-9448
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
FCL-098-017
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805150
—
NC
Enumeration date
12/13/2007
Last updated
06/24/2008
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