Provider Demographics
NPI:1669121034
Name:UNITED FAMILY CARE SERVICE
Entity type:Organization
Organization Name:UNITED FAMILY CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ENDRAIN
Authorized Official - Middle Name:NASH
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-241-1163
Mailing Address - Street 1:6100 TEANECK PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-4063
Mailing Address - Country:US
Mailing Address - Phone:704-241-1163
Mailing Address - Fax:
Practice Address - Street 1:6100 TEANECK PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-4063
Practice Address - Country:US
Practice Address - Phone:704-241-1163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home