Provider Demographics
NPI:1306420294
Name:D&A FAMILY CARE HOME LLC
Entity type:Organization
Organization Name:D&A FAMILY CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-830-5039
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:RIEGELWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:28456-0336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-633-7817
Practice Address - Street 1:15 GUM AVE
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:NC
Practice Address - Zip Code:28423
Practice Address - Country:US
Practice Address - Phone:910-830-5039
Practice Address - Fax:888-633-7817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home