Provider Demographics
NPI:1164726220
Name:AFFIRMATIVE FAMILY CARE SERVICES
Entity Type:Organization
Organization Name:AFFIRMATIVE FAMILY CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-763-5459
Mailing Address - Street 1:1912 WOOD DALE TER
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4643
Mailing Address - Country:US
Mailing Address - Phone:704-763-5459
Mailing Address - Fax:
Practice Address - Street 1:1912 WOOD DALE TER
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4643
Practice Address - Country:US
Practice Address - Phone:704-763-5459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health