Provider Demographics
NPI:1164667036
Name:ANFO CHILDREN AND ADULT SERVICES
Entity Type:Organization
Organization Name:ANFO CHILDREN AND ADULT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-519-8040
Mailing Address - Street 1:2514 N ROXBORO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4348
Mailing Address - Country:US
Mailing Address - Phone:919-519-8040
Mailing Address - Fax:
Practice Address - Street 1:3604 WITHERSPOON BLVD
Practice Address - Street 2:SUITE 111, PMB 233
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6850
Practice Address - Country:US
Practice Address - Phone:919-519-8040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL032460320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness