MEDICARE: ALL UNITED FAMILY SUPPORT 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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1861708687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL UNITED FAMILY SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	230 GATLING ROAD
Second Line	:	P. O. BOX 109
City	:	SUNBURY
State	:	NC
Zip	:	27979-0109
Country	:	US
Telephone Number	:	252-333-0500
Fax Number	:	252-465-4288

Provider Business Practice Location Address
First Line	:	230 GATLING ROAD
Second Line	:
City	:	SUNBURY
State	:	NC
Zip	:	27979-0230
Country	:	US
Telephone Number	:	252-333-0500
Fax Number	:	252-465-4288

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	VALERIE C COSTEN
Credential	:
Telephone Number	:	252-333-0500

Provider Enumeration Date	:	08/31/2010
Last Update Date	:	08/31/2010

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