Provider Demographics
NPI:1093891335
Name:FAMILY PRESERVATION SERVICES, INC
Entity Type:Organization
Organization Name:FAMILY PRESERVATION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL RECORDS
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-993-1229
Mailing Address - Street 1:10304 SPOTSYLVANIA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-8602
Mailing Address - Country:US
Mailing Address - Phone:540-710-6085
Mailing Address - Fax:540-710-6419
Practice Address - Street 1:115 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-710-5810
Practice Address - Fax:540-710-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-30
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA15805001251S00000X
VA158-02-014343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945832Medicaid