Provider Demographics
NPI:1821151028
Name:FAMILY ALTERNATIVES
Entity Type:Organization
Organization Name:FAMILY ALTERNATIVES
Other - Org Name:SHINING STAR CLUBHOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-739-6624
Mailing Address - Street 1:113 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-3029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 JOHN ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3029
Practice Address - Country:US
Practice Address - Phone:910-291-9934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY ALTERNATIVES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-18
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8304106SMedicaid
NC8301406Medicaid