Provider Demographics
NPI:1497892194
Name:FAMILY ADVOCACY SERVICES, LLC
Entity Type:Organization
Organization Name:FAMILY ADVOCACY SERVICES, LLC
Other - Org Name:NEW FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AR COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-543-2112
Mailing Address - Street 1:5720 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1757
Mailing Address - Country:US
Mailing Address - Phone:443-543-2112
Mailing Address - Fax:
Practice Address - Street 1:20 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2204
Practice Address - Country:US
Practice Address - Phone:410-576-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3768251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410310600Medicaid