Provider Demographics
NPI:1033700836
Name:MANIFEST FAMILY SERVICES
Entity Type:Organization
Organization Name:MANIFEST FAMILY SERVICES
Other - Org Name:MANIFEST FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGUERITE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV
Authorized Official - Phone:980-446-0004
Mailing Address - Street 1:PO BOX 1702
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1702
Mailing Address - Country:US
Mailing Address - Phone:980-446-0004
Mailing Address - Fax:980-446-0004
Practice Address - Street 1:110 STOCKTON ST STE M
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5253
Practice Address - Country:US
Practice Address - Phone:980-446-0004
Practice Address - Fax:980-446-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104321Medicaid