Healthcare Provider Details

I. General information

NPI: 1962658211
Provider Name (Legal Business Name): FAMILY PRESERVATION SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 OLD HALIFAX RD
SOUTH BOSTON VA
24592-4951
US

IV. Provider business mailing address

10304 SPOTSYLVANIA AVE 3RD FLOOR
FREDERICKSBURG VA
22408-8602
US

V. Phone/Fax

Practice location:
  • Phone: 434-572-8598
  • Fax: 434-572-6282
Mailing address:
  • Phone: 540-710-6085
  • Fax: 540-710-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number158-03-002
License Number StateVA

VIII. Authorized Official

Name: MR. MICHAEL C FIDGEON
Title or Position: CEO
Credential:
Phone: 540-710-6085