Provider Demographics
NPI:1093982282
Name:EXTENDED FAMILIES OF N. C., LLC
Entity Type:Organization
Organization Name:EXTENDED FAMILIES OF N. C., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:CLYDE
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-335-1478
Mailing Address - Street 1:PO BOX 2661
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27906-2661
Mailing Address - Country:US
Mailing Address - Phone:252-335-1478
Mailing Address - Fax:252-335-2875
Practice Address - Street 1:400 S WATER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4965
Practice Address - Country:US
Practice Address - Phone:252-335-1478
Practice Address - Fax:252-335-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health