Organization
ETHEL'S FAMILY CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ETHEL WELLMON (OWNER)
(704) 482-0596
Entity
Organization
Contact information
Practice address
3825 POLKVILLE RD, SHELBY, NC 28150-8687
(704) 482-0596
Mailing address
3825 POLKVILLE RD, SHELBY, NC 28150-8687
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
FCL023005
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7801056
—
NC
Enumeration date
03/15/2007
Last updated
06/12/2008
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