Provider Demographics
NPI:1174898175
Name:NELLIE'S ADULT CARE HOME
Entity type:Organization
Organization Name:NELLIE'S ADULT CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:919-949-6019
Mailing Address - Street 1:1202 ARNETTE AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-1306
Mailing Address - Country:US
Mailing Address - Phone:919-688-9703
Mailing Address - Fax:919-479-9055
Practice Address - Street 1:1202 ARNETTE AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-1306
Practice Address - Country:US
Practice Address - Phone:919-688-9703
Practice Address - Fax:919-479-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL032116323P00000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility