Provider Demographics
NPI:1710006531
Name:PROMISED LAND FAMILY SERVICES
Entity Type:Organization
Organization Name:PROMISED LAND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERVONIA
Authorized Official - Middle Name:SHERISH
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-276-0487
Mailing Address - Street 1:821 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-4724
Mailing Address - Country:US
Mailing Address - Phone:910-276-0487
Mailing Address - Fax:910-276-4123
Practice Address - Street 1:821 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4724
Practice Address - Country:US
Practice Address - Phone:910-276-0487
Practice Address - Fax:910-276-4123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2538251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408009Medicaid
NC6601067Medicaid