Provider Demographics
NPI:1811031412
Name:UNITED FAMILY NETWORK INC.
Entity Type:Organization
Organization Name:UNITED FAMILY NETWORK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
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 1:9609 KENNEBEC RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-9417
Mailing Address - Country:US
Mailing Address - Phone:919-639-1194
Mailing Address - Fax:
Practice Address - Street 1:9609 KENNEBEC RD
Practice Address - Street 2:
Practice Address - City:WILLOW SPRING
Practice Address - State:NC
Practice Address - Zip Code:27592-9417
Practice Address - Country:US
Practice Address - Phone:919-639-1194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092576322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603685Medicaid
NC6603983Medicaid