Organization
KEY WEST II
Active
Parent organization
FAMILY AFFAIR CARE GROUP MANAGEMENT, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAMILY AFFAIR CARE GROUP MANAGEMENT, INC.
Authorized official
MR. WILLIE LEE GIBSON (PRESIDENT)
(336) 274-1269
Entity
Organization
Contact information
Practice address
1722 ATHENS AVE, DURHAM, NC 27707-4312
(919) 564-7543
Mailing address
1012 GREGORY ST, GREENSBORO, NC 27403-3029
(336) 274-1269
(336) 272-2387
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
06/21/2022
Last updated
06/21/2022
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