Healthcare Provider Details

I. General information

NPI: 1467532978
Provider Name (Legal Business Name): PROFESSIONAL FAMILY CARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 STAMPER RD UNIT 4-5
FAYETTEVILLE NC
28303-4215
US

IV. Provider business mailing address

PO BOX 35150
FAYETTEVILLE NC
28303-0150
US

V. Phone/Fax

Practice location:
  • Phone: 910-485-0085
  • Fax:
Mailing address:
  • Phone: 910-485-0085
  • Fax: 910-485-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberMHL026894
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BENSON OTOVO
Title or Position: EXECUTIVE DIRECTOR/PRESIDENT
Credential: MBA
Phone: 910-485-0085