Provider Demographics
NPI:1114005303
Name:FAMILY PRESERVATION SERVICES, INC
Entity Type:Organization
Organization Name:FAMILY PRESERVATION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FIDGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-710-6085
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:540-710-6080
Mailing Address - Fax:540-710-6419
Practice Address - Street 1:6899 VIRGINIA
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:VA
Practice Address - Zip Code:24136
Practice Address - Country:US
Practice Address - Phone:540-381-7500
Practice Address - Fax:540-381-7658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA15802029251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health