Provider Demographics
NPI:1093837924
Name:FAMILY HABILITATIVE SERVICES
Entity Type:Organization
Organization Name:FAMILY HABILITATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KENYETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-487-5490
Mailing Address - Street 1:3441 LUBBOCK DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-9637
Mailing Address - Country:US
Mailing Address - Phone:910-487-5490
Mailing Address - Fax:910-864-1781
Practice Address - Street 1:3441 LUBBOCK DR
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-9637
Practice Address - Country:US
Practice Address - Phone:910-487-5490
Practice Address - Fax:910-864-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408287Medicaid