Provider Demographics
NPI:1578698049
Name:FAMILY FIRST COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:FAMILY FIRST COMMUNITY SERVICES LLC
Other - Org Name:FAMILY FIRST COMMUNITY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHIKO
Authorized Official - Middle Name:K
Authorized Official - Last Name:DOWDY
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:704-364-3989
Mailing Address - Street 1:3705 LATROBE DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4824
Mailing Address - Country:US
Mailing Address - Phone:704-364-3989
Mailing Address - Fax:704-364-3974
Practice Address - Street 1:3705 LATROBE DR
Practice Address - Street 2:SUITE 340
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4824
Practice Address - Country:US
Practice Address - Phone:704-364-3989
Practice Address - Fax:704-364-3974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301830Medicaid