Mildred Blackwell
Organization Active NPI Adult Care Home Facility · Elon, NC
NPI 1164542882 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1164542882
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adult Care Home Facility 311ZA0620X
- License
- HAL017003 (NC)
- Legal business name
- MILDRED BLACKWELL
- Practice address
- 3658 Cherry Grove Rd
Elon, NC 27244-9483 - Phone
- (336) 421-0646
- NPI assigned
- Mar 29, 2007
- Organization subpart
- No
Authorized official
- Name
- Ms. Mildred Blackwell
- Title
- Owner
- Phone
- (336) 421-0646
Corporate family (same tax ID) 1
National Provider Directory
- Tax ID family
- Dogwood Forest Family Care Two
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | HAL017003 | NC | Yes |
Addresses
Primary practice location
3658 Cherry Grove Rd
Elon, NC 27244-9483
Mailing address
203 N Main St
Suite 315
Roxboro, NC 27573-5343
Phone (336) 421-0646
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7801723 | Medicaid | NC |
Other names
- Dogwood Forest No. Two
Other providers in Elon, NC
- Carolyn Westbrook McLamb
- Heather Williams McMahon
- Lura Elizabeth McMurray
- Joshua F Medlin
- Angela Meikle
- Veronica Mondaca
- Marcia Liliana Moran
- Stephanie Morrow
- Amanda C Morsell
- Ashley Bennett Motley
All providers in Elon, NC · Adult Care Home Facility in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.