Healthcare Provider Details

I. General information

NPI: 1609051275
Provider Name (Legal Business Name): JOHARI FAMILY SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MIDDLE RD
FAYETTEVILLE NC
28312-5207
US

IV. Provider business mailing address

511 MIDDLE RD
FAYETTEVILLE NC
28312-5207
US

V. Phone/Fax

Practice location:
  • Phone: 910-897-3000
  • Fax: 910-897-3004
Mailing address:
  • Phone: 910-897-3000
  • Fax: 910-897-3004

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 Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. JOY JOHARI INNISS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 910-897-3000