Provider Demographics
NPI:1386837003
Name:FAMILY PRESERVATION SERVICES
Entity Type:Organization
Organization Name:FAMILY PRESERVATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FIDGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-710-6085
Mailing Address - Street 1:10304 SPOTSYLVANIA AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-8602
Mailing Address - Country:US
Mailing Address - Phone:540-710-6085
Mailing Address - Fax:540-710-6447
Practice Address - Street 1:231 FLOWER GAP RD
Practice Address - Street 2:
Practice Address - City:CANA
Practice Address - State:VA
Practice Address - Zip Code:24317-3896
Practice Address - Country:US
Practice Address - Phone:276-238-8885
Practice Address - Fax:276-238-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA15802029251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========Medicaid