Provider Demographics
NPI:1689865958
Name:UNITED FAMILY NETWORK AT WILLOW SPRINGS
Entity Type:Organization
Organization Name:UNITED FAMILY NETWORK AT WILLOW SPRINGS
Other - Org Name:UNITED FAMILY NETWORK INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:910-578-6806
Mailing Address - Street 1:1259 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:ANTIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501
Mailing Address - Country:US
Mailing Address - Phone:919-894-2040
Mailing Address - Fax:919-331-0026
Practice Address - Street 1:1259 RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:ANTIER
Practice Address - State:NC
Practice Address - Zip Code:27501
Practice Address - Country:US
Practice Address - Phone:919-894-2040
Practice Address - Fax:919-331-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092-576322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603685MedicaidLEVEL III RESIDENTIAL