Healthcare Provider Details

I. General information

NPI: 1306687967
Provider Name (Legal Business Name): FAMILY FIRST GENERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 QUINCY ST
GREENSBORO NC
27401-3951
US

IV. Provider business mailing address

5510 TRADERS WAY
GREENSBORO NC
27407-5407
US

V. Phone/Fax

Practice location:
  • Phone: 336-340-1671
  • Fax:
Mailing address:
  • Phone: 336-858-7699
  • Fax:

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 Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHLEY NICOLE HAITH
Title or Position: OWNER
Credential: MS, EDD
Phone: 336-858-7699