NPIMap

Organization Active NPI

Mildreds Family Care,Inc.

  • Custodial Care Facility
  • Yanceyville, NC
National Provider Identifier
1083983928
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Custodial Care FacilityTaxonomy code 311Z00000X
License
FCL-017-006 Issued in NC
Legal business name
MILDREDS FAMILY CARE,INC.
Practice address
3592 Marshall Graves Rd
Yanceyville, NC 27379-8630
Phone
(336) 213-2132
Fax
(336) 421-5666
NPI assigned
Dec 21, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Carl Lavalle Blackwell Jr.
Title
President
Phone
(336) 421-0646

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Custodial Care Facility 311Z00000X FCL-017-006 NC Primary

Addresses

Primary practice location

3592 Marshall Graves Rd
Yanceyville, NC 27379-8630

Mailing address

3592 Marshall Graves Rd
Yanceyville, NC 27379-8630
Phone (336) 421-0646

Other names 1

  • Mildred''s Family Care,Inc Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700179200000",
    "number": "1083983928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3592 MARSHALL GRAVES RD",
            "city": "YANCEYVILLE",
            "state": "NC",
            "postal_code": "273798630",
            "telephone_number": "336-421-0646",
            "fax_number": "336-421-5666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3592 MARSHALL GRAVES RD",
            "city": "YANCEYVILLE",
            "state": "NC",
            "postal_code": "273798630",
            "telephone_number": "336-213-2132",
            "fax_number": "336-421-5666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILDREDS FAMILY CARE,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-21",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A",
        "authorized_official_last_name": "BLACKWELL",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "LAVALLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-421-0646",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "NC",
            "license": "FCL-017-006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mildred''s Family Care,Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Yanceyville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.