Healthcare Provider Details

I. General information

NPI: 1972479459
Provider Name (Legal Business Name): FIRM FOUNDATION CHILDEN SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N PLYMOUTH ST
FAYETTEVILLE NC
28312-5349
US

IV. Provider business mailing address

705 CUMBERLAND ST
FAYETTEVILLE NC
28301-7020
US

V. Phone/Fax

Practice location:
  • Phone: 910-485-5173
  • Fax: 910-485-1453
Mailing address:
  • Phone: 910-485-3332
  • Fax: 910-485-3332

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 Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES DONALD DAVENPORT JR.
Title or Position: CEO
Credential:
Phone: 910-263-1687