Provider Demographics
NPI:1225176480
Name:FAMILY ADVOCACY SERVICES, LLC
Entity Type:Organization
Organization Name:FAMILY ADVOCACY SERVICES, LLC
Other - Org Name:FLORENCE BERTELL ACADEMY OF BALTIMORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AR COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLEN-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-543-2116
Mailing Address - Street 1:5720 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1757
Mailing Address - Country:US
Mailing Address - Phone:443-543-2116
Mailing Address - Fax:443-543-2190
Practice Address - Street 1:7131 RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2702
Practice Address - Country:US
Practice Address - Phone:410-298-2691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3337251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD450910200Medicaid