Provider Demographics
NPI:1861616872
Name:NEEDHAM FAMILY CARE HOME INC
Entity type:Organization
Organization Name:NEEDHAM FAMILY CARE HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ADMINISTRATOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:NEEDHAM
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:252-336-4344
Mailing Address - Street 1:916 SANDY HOOK RD
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:NC
Mailing Address - Zip Code:27974
Mailing Address - Country:US
Mailing Address - Phone:252-336-4344
Mailing Address - Fax:252-336-4344
Practice Address - Street 1:916 SANDY HOOK RD
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:NC
Practice Address - Zip Code:27974
Practice Address - Country:US
Practice Address - Phone:252-336-4344
Practice Address - Fax:252-336-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFLC15001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801023Medicaid