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NPI Code Detail

MEDICARE: FAMILY PRESERVATION SERVICES OF NORTH CAROLINA LLC

MEDICARE: FAMILY PRESERVATION SERVICES OF NORTH CAROLINA LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740312107
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY PRESERVATION SERVICES OF NORTH CAROLINA LLC
Provider Business Mailing Address
First Line : PO BOX 759194
Second Line :
City : BALTIMORE
State : MD
Zip : 21275-9194
Country : US
Telephone Number : 704-344-0491
Fax Number : 704-344-0493
Provider Business Practice Location Address
First Line : 2300 SARDIS RD N STE M
Second Line :
City : CHARLOTTE
State : NC
Zip : 28227-7712
Country : US
Telephone Number : 704-344-0491
Fax Number :
Authorized Official
Title or Position : NC BILLING SYSTEM SUPERVISOR
Name : PAMELA L FREELEY
Credential :
Telephone Number : 704-344-0491
Provider Enumeration Date : 03/12/2007
Last Update Date : 12/04/2018

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Directions to “FAMILY PRESERVATION SERVICES OF NORTH CAROLINA LLC ” Practice Location

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