Provider Demographics
NPI:1407628068
Name:JOHNETTE PERSONAL FAMILY CARE HOME
Entity type:Organization
Organization Name:JOHNETTE PERSONAL FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TINEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-480-6535
Mailing Address - Street 1:7800 FALLS OF NEUSE RD
Mailing Address - Street 2:PO BOX 97576
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:984-480-6535
Mailing Address - Fax:
Practice Address - Street 1:1924 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-6313
Practice Address - Country:US
Practice Address - Phone:252-231-1276
Practice Address - Fax:252-231-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No177F00000XOther Service ProvidersLodging
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility