Provider Demographics
NPI:1467532978
Name:PROFESSIONAL FAMILY CARE SERVICES, INC
Entity Type:Organization
Organization Name:PROFESSIONAL FAMILY CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENSON
Authorized Official - Middle Name:
Authorized Official - Last Name:OTOVO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:910-485-0085
Mailing Address - Street 1:PO BOX 35150
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-0150
Mailing Address - Country:US
Mailing Address - Phone:910-485-0085
Mailing Address - Fax:910-485-0334
Practice Address - Street 1:811 STAMPER RD UNIT 4-5
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4215
Practice Address - Country:US
Practice Address - Phone:910-485-0085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL026894251B00000X
251S00000X, 261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301551BMedicaid