Healthcare Provider Details

I. General information

NPI: 1447335989
Provider Name (Legal Business Name): F.A.C.T. SPECIALIZED SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HENDERSON DR STE A&B
JACKSONVILLE NC
28540-5602
US

IV. Provider business mailing address

1041 WASHINGTON ST
RALEIGH NC
27605-1259
US

V. Phone/Fax

Practice location:
  • Phone: 910-346-3744
  • Fax: 910-346-5344
Mailing address:
  • Phone: 919-833-2834
  • Fax: 919-755-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL067140
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL067101
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL067133
License Number StateNC

VIII. Authorized Official

Name: SUSAN FRANKFORT
Title or Position: QI DIRECTOR
Credential:
Phone: 919-754-3638