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General NPI Number Information
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NPI Number | 1770748659
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Entity Type | Organization
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Legal Business Name | FAMILY PRESEVATION SERVICES, INC.
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 134 WILDEN ST
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City | MARION
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State | VA
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Zip | 24354-3338
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Country | US
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Telephone | 276-623-9245
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Fax | 276-623-1183
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Provider Business Mailing Address
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Address Line | 10304 SPOTSYLVANIA AVE 3RD FLOOR
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-8602
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Country | US
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Telephone | 540-710-6085
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Fax | 540-710-6447
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL C. FIDGEON
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Credential |
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Telephone | 540-710-6085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 158-02-029
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License Number State | VA
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