MEDICARE: NEXT STATE FAMILY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	MHL-036-228	NC

General Provider Information

NPI Number	:	1295863264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXT STATE FAMILY SERVICES

Provider Business Mailing Address
First Line	:	1041 FORD DR.
Second Line	:
City	:	LOWELL
State	:	NC
Zip	:	28098
Country	:	US
Telephone Number	:	704-824-8416
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 FORD DR.
Second Line	:
City	:	LOWELL
State	:	NC
Zip	:	28098
Country	:	US
Telephone Number	:	704-824-8416
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RALPH FRONEBERGER
Credential	:
Telephone Number	:	803-327-6265

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	08/22/2020

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Directions to “NEXT STATE FAMILY SERVICES ” Practice Location

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