MEDICARE: INTEGRATED FAMILY SERVICES, PLLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1356894638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED FAMILY SERVICES, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 885
Second Line	:
City	:	AHOSKIE
State	:	NC
Zip	:	27910-0885
Country	:	US
Telephone Number	:	252-439-0700
Fax Number	:	252-439-0900

Provider Business Practice Location Address
First Line	:	3383 HENDERSON DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-5231
Country	:	US
Telephone Number	:	910-939-6475
Fax Number	:

Authorized Official
Title or Position	:	ASST. ADMIN. DIRECTOR
Name	:	MRS. TINA MARIE PHILLIPS
Credential	:
Telephone Number	:	252-439-0700

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	08/03/2016

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