Healthcare Provider Details

I. General information

NPI: 1194700773
Provider Name (Legal Business Name): LUTHERAN FAMILY SERVICES IN THE CAROLINAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3257 LAKE WOODARD DR
RALEIGH NC
27604-3660
US

IV. Provider business mailing address

PO BOX 2369
SALISBURY NC
28145-2369
US

V. Phone/Fax

Practice location:
  • Phone: 919-922-3186
  • Fax:
Mailing address:
  • Phone: 704-754-8232
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KIRBY NICKERSON
Title or Position: CFO
Credential:
Phone: 704-754-8228