Provider Demographics
NPI:1386081909
Name:ANTHONY STREET FAMILY CARE HOME
Entity type:Organization
Organization Name:ANTHONY STREET FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:VONZELL
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-228-7897
Mailing Address - Street 1:123 S ANTHONY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-6601
Mailing Address - Country:US
Mailing Address - Phone:336-228-7897
Mailing Address - Fax:336-228-1523
Practice Address - Street 1:123 S ANTHONY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-6601
Practice Address - Country:US
Practice Address - Phone:336-228-7897
Practice Address - Fax:336-228-1523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home