Provider Demographics
NPI:1992420434
Name:CLYBURN FAMILY LIVING, LLC
Entity type:Organization
Organization Name:CLYBURN FAMILY LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CLYBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-214-5408
Mailing Address - Street 1:700 CROSWELL CT
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-9301
Mailing Address - Country:US
Mailing Address - Phone:336-214-5408
Mailing Address - Fax:
Practice Address - Street 1:607 LANCASTER RD
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-7570
Practice Address - Country:US
Practice Address - Phone:336-214-5408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health