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General NPI Number Information
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NPI Number | 1447331475
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Entity Type | Organization
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Legal Business Name | F.A.C.T. SPECIALIZED SERVICES, INC.
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 109 SILVERLEAF DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-7360
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Country | US
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Telephone | 910-353-1903
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Fax | 910-577-4568
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Provider Business Mailing Address
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Address Line | 109 SILVERLEAF DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-7360
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Country | US
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Telephone | 910-353-1903
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Fax | 910-577-4568
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Authorized Official
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Title or Position | QI DIRECTOR
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Name | SUSAN WINNINGHAM
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Credential |
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Telephone | 910-346-3744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL067133
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License Number State | NC
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