Provider Demographics
NPI:1033465075
Name:FERNANDEZ COMMUNITY CENTER, LLC
Entity Type:Organization
Organization Name:FERNANDEZ COMMUNITY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YANET
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:919-449-1084
Mailing Address - Street 1:8376 SIX FORKS RD STE 104
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5095
Mailing Address - Country:US
Mailing Address - Phone:919-900-7438
Mailing Address - Fax:919-900-7576
Practice Address - Street 1:8522 SIX FORKS RD STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3098
Practice Address - Country:US
Practice Address - Phone:919-900-7438
Practice Address - Fax:919-900-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty