Healthcare Provider Details

I. General information

NPI: 1811031412
Provider Name (Legal Business Name): UNITED FAMILY NETWORK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9609 KENNEBEC RD
WILLOW SPRING NC
27592-9417
US

IV. Provider business mailing address

9609 KENNEBEC RD
WILLOW SPRING NC
27592-9417
US

V. Phone/Fax

Practice location:
  • Phone: 919-639-1194
  • Fax:
Mailing address:
  • Phone: 919-639-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-092576
License Number StateNC

VIII. Authorized Official

Name: MR. CHRIS SIMMONS I
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 910-578-6806