Organization
MAE CORBETT CONNALLY
Active
Other names
Corbett FCH
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAE CORBETT CONNELLY (OWNER)
(336) 234-7502
Entity
Organization
Contact information
Practice address
362 HUDSON RD, MILTON, NC 27305-9680
(336) 234-7502
Mailing address
203 N MAIN ST, SUITE 315, ROXBORO, NC 27573-5343
(336) 234-7502
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
FCL017003
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7802646
—
NC
Enumeration date
03/29/2007
Last updated
06/19/2008
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