MEDICARE: FAMILY PRESERVATION SERVICES OF NORTH CAROLINA, LLC FLAT ROCK MIDDLE

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871873422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRESERVATION SERVICES OF NORTH CAROLINA, LLC FLAT ROCK MIDDLE

Provider Business Mailing Address
First Line	:	PO BOX 759194
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21275-9194
Country	:	US
Telephone Number	:	828-225-3100
Fax Number	:	828-225-3604

Provider Business Practice Location Address
First Line	:	191 PRESTON LN
Second Line	:
City	:	EAST FLAT ROCK
State	:	NC
Zip	:	28726-2865
Country	:	US
Telephone Number	:	704-344-0491
Fax Number	:	704-344-0493

Authorized Official
Title or Position	:	NC BILLING SYSTEM SUPERVISOR
Name	:	PAMELA L FREELEY
Credential	:
Telephone Number	:	704-344-0491

Provider Enumeration Date	:	08/26/2011
Last Update Date	:	12/04/2018

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