Provider Demographics
NPI:1336479625
Name:FAMILY & YOUTH SERVICES INC.
Entity Type:Organization
Organization Name:FAMILY & YOUTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-680-2345
Mailing Address - Street 1:102 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27702-1327
Mailing Address - Country:US
Mailing Address - Phone:919-680-2345
Mailing Address - Fax:919-226-0623
Practice Address - Street 1:102 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27702-1327
Practice Address - Country:US
Practice Address - Phone:919-680-2345
Practice Address - Fax:919-226-0623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301559Medicaid
NC8301558Medicaid
NC8301557Medicaid