Provider Demographics
NPI:1639489859
Name:INTENSIVE FAMILY SERVICES
Entity Type:Organization
Organization Name:INTENSIVE FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRUMAINE
Authorized Official - Middle Name:RODERICK
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:704-756-5254
Mailing Address - Street 1:10912 POINT SOUTH DR APT J
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6570
Mailing Address - Country:US
Mailing Address - Phone:704-756-5254
Mailing Address - Fax:
Practice Address - Street 1:10912 POINT SOUTH DR APT J
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6570
Practice Address - Country:US
Practice Address - Phone:704-756-5254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health