MEDICARE: FFC INSTITUTE FOR CHANGE INC

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	251S00000X	NC

General Provider Information

NPI Number	:	1861643876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FFC INSTITUTE FOR CHANGE INC

Provider Business Mailing Address
First Line	:	333 JEFFERSON ST
Second Line	:
City	:	WHITEVILLE
State	:	NC
Zip	:	28472-3601
Country	:	US
Telephone Number	:	910-640-5506
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 JEFFERSON ST
Second Line	:
City	:	WHITEVILLE
State	:	NC
Zip	:	28472-3601
Country	:	US
Telephone Number	:	910-642-6915
Fax Number	:	910-642-3960

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	FONDA D CLARK
Credential	:
Telephone Number	:	910-642-6915

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/08/2008

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