Provider Demographics
NPI:1477690436
Name:LUTHERAN FAMILY SERVICES IN THE CAROLINAS
Entity Type:Organization
Organization Name:LUTHERAN FAMILY SERVICES IN THE CAROLINAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-754-8228
Mailing Address - Street 1:PO BOX 2369
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28145-2369
Mailing Address - Country:US
Mailing Address - Phone:704-637-2870
Mailing Address - Fax:
Practice Address - Street 1:891 WILLOW DR STE 2
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7077
Practice Address - Country:US
Practice Address - Phone:919-968-2552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300820AMedicaid
NC8300820Medicaid