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1912060062

NPI Code Detail

MEDICARE: FAMILY QUALITY CARE SERVICE ,INC.

MEDICARE: FAMILY QUALITY CARE SERVICE ,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	251B00000X	Case Management Agency	032-328	NC
2	251C00000X	Developmentally Disabled Services Day Training Agency	032-328	NC
3	251E00000X	Home Health Agency	HC2967	NC
4	251S00000X	Community/Behavioral Health Agency	032-328	NC
5	261QH0100X	Health Service Clinic/Center	032-328	NC
6	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	032-038	NC
7	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	032-328	NC
8	261QM0855X	Adolescent and Children Mental Health Clinic/Center	032-328	NC
9	347C00000X	Private Vehicle	032-328	NC
10	2084P0804X	Child & Adolescent Psychiatry Physician
11	2084P0800X	Psychiatry Physician
12	251300000X	Local Education Agency (LEA)	032-328	NC

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912060062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY QUALITY CARE SERVICE ,INC.

Provider Business Mailing Address
First Line	:	PO BOX 11265
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-0265
Country	:	US
Telephone Number	:	919-237-2225
Fax Number	:	919-237-2226

Provider Business Practice Location Address
First Line	:	1812 LIBERTY ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-2271
Country	:	US
Telephone Number	:	919-237-2225
Fax Number	:	919-237-2225

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. SANDRA DENISE LASSITER
Credential	:
Telephone Number	:	919-237-2225

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	09/26/2007

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Directions to “FAMILY QUALITY CARE SERVICE ,INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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