MEDICARE: FAMILY BEHAVIORAL HEALTH SERVICES, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253J00000X	Foster Care Agency
2	253Z00000X	In Home Supportive Care Agency
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1427586700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY BEHAVIORAL HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	1528 UNION RD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-2200
Country	:	US
Telephone Number	:	704-995-4724
Fax Number	:	704-864-1476

Provider Business Practice Location Address
First Line	:	1528 UNION RD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-2200
Country	:	US
Telephone Number	:	704-995-4724
Fax Number	:	704-864-1476

Authorized Official
Title or Position	:	CEO
Name	:	HOLLY SHIVADECKER
Credential	:
Telephone Number	:	704-995-4724

Provider Enumeration Date	:	05/31/2017
Last Update Date	:	07/21/2022

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