Provider Demographics
NPI:1962637397
Name:FAMILY PRESERVATION SERVICES OF NORTH CAROLINA, LLC
Entity Type:Organization
Organization Name:FAMILY PRESERVATION SERVICES OF NORTH CAROLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NC BILLING SYSTEM SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FREELEY
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:828-859-6661
Mailing Address - Fax:828-859-9487
Practice Address - Street 1:94 WHITE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-4439
Practice Address - Country:US
Practice Address - Phone:828-859-6661
Practice Address - Fax:828-859-9487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301587HMedicaid