Healthcare Provider Details

I. General information

NPI: 1871873422
Provider Name (Legal Business Name): FAMILY PRESERVATION SERVICES OF NORTH CAROLINA, LLC FLAT ROCK MIDDLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 PRESTON LN
EAST FLAT ROCK NC
28726-2865
US

IV. Provider business mailing address

PO BOX 759194
BALTIMORE MD
21275-9194
US

V. Phone/Fax

Practice location:
  • Phone: 704-344-0491
  • Fax: 704-344-0493
Mailing address:
  • Phone: 828-225-3100
  • Fax: 828-225-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PAMELA L FREELEY
Title or Position: NC BILLING SYSTEM SUPERVISOR
Credential:
Phone: 704-344-0491