Provider Demographics
NPI:1922130392
Name:FAMILY PRESERVATION SERVICES OF NORTH CAROLINA INC
Entity Type:Organization
Organization Name:FAMILY PRESERVATION SERVICES OF NORTH CAROLINA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL 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 1:4601 PARK RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3239
Mailing Address - Country:US
Mailing Address - Phone:704-344-0491
Mailing Address - Fax:704-344-0493
Practice Address - Street 1:4601 PARK RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3239
Practice Address - Country:US
Practice Address - Phone:704-344-0491
Practice Address - Fax:704-344-0493
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY PRESERVATION SERVICES OF NORTH CAROLINA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-12
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300284BMedicaid