Provider Demographics
NPI:1568696680
Name:FAFLI INC
Entity Type:Organization
Organization Name:FAFLI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:IGWILO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-854-8855
Mailing Address - Street 1:175 W. MAIL AVENUE
Mailing Address - Street 2:
Mailing Address - City:GASTON COUNTY
Mailing Address - State:NC
Mailing Address - Zip Code:28052
Mailing Address - Country:US
Mailing Address - Phone:704-854-8855
Mailing Address - Fax:704-854-8850
Practice Address - Street 1:175 W. MAIN AVENUE
Practice Address - Street 2:
Practice Address - City:GASTON COUNTY
Practice Address - State:NC
Practice Address - Zip Code:28052
Practice Address - Country:US
Practice Address - Phone:704-854-8855
Practice Address - Fax:704-854-8850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC303680251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health