Organization
WILLIE EVANS
Active
Other names
WHITE STORE FAMILY CARE HOME
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIE EVANS (OWNER)
(704) 296-5162
Entity
Organization
Contact information
Practice address
2101 WHITE STORE RD, MONROE, NC 28112-8733
(704) 292-5162
(704) 282-4142
Mailing address
2101 WHITE STORE RD, MONROE, NC 28112-8733
(704) 292-5162
(704) 282-4142
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
FCL090012
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7802668
—
NC
Enumeration date
01/10/2007
Last updated
06/26/2008
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