Provider Demographics
NPI:1467647990
Name:MIDDLE TRACK UNITED FAMILY SERVICES
Entity Type:Organization
Organization Name:MIDDLE TRACK UNITED FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:RAZOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:252-794-1555
Mailing Address - Street 1:119 E GRANVILLE ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-1230
Mailing Address - Country:US
Mailing Address - Phone:252-794-1555
Mailing Address - Fax:252-794-1556
Practice Address - Street 1:119 E GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-1230
Practice Address - Country:US
Practice Address - Phone:252-794-1555
Practice Address - Fax:252-794-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-008-026251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301132BMedicaid