Provider Demographics
NPI:1578753539
Name:FIELDS FOUNDATION
Entity Type:Organization
Organization Name:FIELDS FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:252-224-0150
Mailing Address - Street 1:9400 US HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:POLLOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28573-9490
Mailing Address - Country:US
Mailing Address - Phone:252-224-0150
Mailing Address - Fax:
Practice Address - Street 1:9400 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:POLLOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28573-9490
Practice Address - Country:US
Practice Address - Phone:252-224-0150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-052-014320600000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities