Provider Demographics
NPI:1275881088
Name:FAMILY PRESERVATION SERVICES OF NC, INC - CHALONER
Entity Type:Organization
Organization Name:FAMILY PRESERVATION SERVICES OF NC, INC - CHALONER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NC STATE QI & TRAINING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-344-0491
Mailing Address - Street 1:P.O. BOX 759194
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-9194
Mailing Address - Country:US
Mailing Address - Phone:704-344-0491
Mailing Address - Fax:704-344-0493
Practice Address - Street 1:2100 VIRGINIA AVE.
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4736
Practice Address - Country:US
Practice Address - Phone:704-344-0491
Practice Address - Fax:704-344-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health