Healthcare Provider Details

I. General information

NPI: 1578619938
Provider Name (Legal Business Name): LUTHERAN FAMILY SERVICES IN THE CAROLINAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 06/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6590 ROLLINGWOOD DR
CLEMMONS NC
27012-9119
US

IV. Provider business mailing address

PO BOX 2369
SALISBURY NC
28145
US

V. Phone/Fax

Practice location:
  • Phone: 336-766-9833
  • Fax:
Mailing address:
  • Phone: 704-637-2870
  • Fax: 704-637-2950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL034174
License Number State

VIII. Authorized Official

Name: KIRBY NICKERSON
Title or Position: CFO
Credential:
Phone: 704-637-2870