Organization
ETTALOVE FAMILY CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA YVETTE WASHINGTON (ADMINISTRATOR)
(704) 509-5596
Entity
Organization
Contact information
Practice address
1951 DIETRICH LN, CHARLOTTE, NC 28262-3526
(704) 509-5596
(704) 509-5596
Mailing address
1951 DIETRICH LN, CHARLOTTE, NC 28262-3526
(704) 509-5596
(704) 509-5596
Taxonomy
Speciality
Code
Description
License number
State
261QA0005X
Ambulatory Family Planning Facility
Primary
FCL-060-072
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805172
—
NC
Enumeration date
06/05/2008
Last updated
06/05/2008
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