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General NPI Number Information
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NPI Number | 1578971347
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Entity Type | Organization
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Legal Business Name | FAMILY FIRST GROUP HOME
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 1712 SHILOH DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4027
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Country | US
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Telephone | 910-495-6137
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Fax | 910-426-1200
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Provider Business Mailing Address
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Address Line | 817 BRAMBLEGATE RD
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City | HOPE MILLS
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State | NC
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Zip | 28348-5697
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Country | US
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Telephone | 910-495-6137
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Fax | 910-426-1200
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRANDI HUNT
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Credential |
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Telephone | 910-495-6137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHL-026-957
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License Number State | NC
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