Provider Demographics
NPI:1487773008
Name:MEBANE'S FAMILY CARE #2
Entity type:Organization
Organization Name:MEBANE'S FAMILY CARE #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEBANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-227-0569
Mailing Address - Street 1:939 LAKESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-9724
Mailing Address - Country:US
Mailing Address - Phone:336-227-0569
Mailing Address - Fax:336-227-1460
Practice Address - Street 1:939 LAKESIDE AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-9724
Practice Address - Country:US
Practice Address - Phone:336-227-0569
Practice Address - Fax:336-227-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-001-026311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801693Medicaid