Provider Demographics
NPI:1528102803
Name:MURRAY FORK HOME CARE
Entity type:Organization
Organization Name:MURRAY FORK HOME CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-670-0917
Mailing Address - Street 1:PO BOX 35674
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-0674
Mailing Address - Country:US
Mailing Address - Phone:910-480-4181
Mailing Address - Fax:910-480-4182
Practice Address - Street 1:209 MURRAY FORK DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0902
Practice Address - Country:US
Practice Address - Phone:910-480-4181
Practice Address - Fax:910-480-4182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-026-647322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603226Medicaid