Provider Demographics
NPI:1710321344
Name:FAMILY PRESERVATION SERVICES OF NC INC - EATON JOHNSON MIDDLE
Entity Type:Organization
Organization Name:FAMILY PRESERVATION SERVICES OF NC INC - EATON JOHNSON MIDDLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NC STATE QI & TRAINNG DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-344-0491
Mailing Address - Street 1:PO BOX 759194
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-9194
Mailing Address - Country:US
Mailing Address - Phone:252-438-5017
Mailing Address - Fax:252-738-0250
Practice Address - Street 1:500 N BECKFORD DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2653
Practice Address - Country:US
Practice Address - Phone:252-438-5017
Practice Address - Fax:252-738-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health