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Organization

MAYOS LOVING CARE ADULT GROUP HOME

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. SAMUEL CORMELIUS MAYO SR. LRT/CTRS (QP/CO-OWNER)
(252) 281-7717
Entity
Organization

Contact information

Practice address
105 KRISTA LN, ROCKY MOUNT, NC 27803-5228
(252) 973-8593
(252) 407-4950
Mailing address
105 KRISTA LN, ROCKY MOUNT, NC 27803-5228
(252) 973-8593
(252) 407-4950

Taxonomy

Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
MHL064115
NC
347C00000X
Private Vehicle
MHL064115
NC

Other

Enumeration date
07/14/2010
Last updated
07/14/2010
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