Organization
FAMILY HOME LIFE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH GRAY TANNER (DIRECTOR)
(252) 533-9200
Entity
Organization
Contact information
Practice address
544 JULIAN R ALLSBROOK HWY, ROANOKE RAPIDS, NC 27870-4611
(252) 533-9200
(252) 537-7458
Mailing address
PO BOX 66, ROANOKE RAPIDS, NC 27870-0066
(252) 533-9200
(252) 537-7458
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL-042-042
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300261Q
—
NC
Enumeration date
08/29/2007
Last updated
08/29/2007
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