Tamela Blackwell

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

FCL017006 Issued in NC

Legal business name

TAMELA BLACKWELL

Doing business as

Dogwood Forest Family Care Home Two

Practice address

3592 Marshall Graves Rd
Yanceyville, NC 27379-8630

Phone

(336) 421-8880

NPI assigned

Mar 29, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Tamela Blackwell

Title

Owner

Phone

(336) 421-8880

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dogwood Forest Family Care Home Two Doing business as

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689794323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 N MAIN ST",
            "address_2": "SUITE 315",
            "city": "ROXBORO",
            "state": "NC",
            "postal_code": "275735343",
            "telephone_number": "336-421-8880"
        },
        {
            "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": "336-421-8880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAMELA BLACKWELL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLACKWELL",
        "authorized_official_first_name": "TAMELA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-421-8880",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "FCL017006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7803662",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dogwood Forest Family Care Home Two",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Care Home Facility in Yanceyville, NC
• Providers in Yanceyville, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.