Provider Demographics
NPI:1215197835
Name:PAM FOGLEMAN
Entity type:Organization
Organization Name:PAM FOGLEMAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AFL PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:TALLEY
Authorized Official - Last Name:FOGLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-304-6144
Mailing Address - Street 1:1205 BETHPAGE DR
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-8372
Mailing Address - Country:US
Mailing Address - Phone:919-304-6144
Mailing Address - Fax:919-304-6144
Practice Address - Street 1:1205 BETHPAGE DR
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-8372
Practice Address - Country:US
Practice Address - Phone:919-304-6144
Practice Address - Fax:919-304-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001-128385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care