Healthcare Provider Details

I. General information

NPI: 1093891335
Provider Name (Legal Business Name): FAMILY PRESERVATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5369 PETERS CREEK RD NW
ROANOKE VA
24019-3849
US

IV. Provider business mailing address

10304 SPOTSYLVANIA AVE SUITE 300
FREDERICKSBURG VA
22408-8602
US

V. Phone/Fax

Practice location:
  • Phone: 540-344-9501
  • Fax: 540-344-7162
Mailing address:
  • Phone: 540-710-6085
  • Fax: 540-710-6419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number15805001
License Number StateVA

VIII. Authorized Official

Name: MELANIE JOHNSON
Title or Position: AVP OF RCM
Credential:
Phone: 540-710-6085