Basic Information
| Provider Information | |||||||||
| NPI: | 1609494897 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | P&C ADULT CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1002 BELL RIDGE CT | ||||||||
| Address2: | |||||||||
| City: | ROCKWELL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281387437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042392199 | ||||||||
| FaxNumber: | 7048568196 | ||||||||
| Practice Location | |||||||||
| Address1: | 1345 CHAPMAN LN | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286581778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284646490 | ||||||||
| FaxNumber: | 8284663002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2020 | ||||||||
| LastUpdateDate: | 07/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | BLACK | ||||||||
| AuthorizedOfficialFirstName: | CASEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER MANGER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7042392199 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 07/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311ZA0620X | Y | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
No ID Information.