Healthcare Provider Details

I. General information

NPI: 1194876425
Provider Name (Legal Business Name): FAMILY SOLUTIONS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 HIDDEN CREEK DR
ADVANCE NC
27006-8754
US

IV. Provider business mailing address

137 HIDDEN CREEK DR
ADVANCE NC
27006-8754
US

V. Phone/Fax

Practice location:
  • Phone: 336-998-1652
  • Fax: 336-998-1652
Mailing address:
  • Phone: 336-998-1652
  • Fax: 336-998-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNC

VIII. Authorized Official

Name: MS. WILLENE TILLMAN
Title or Position: OWNER/MANAGER
Credential:
Phone: 336-998-1652