Provider Demographics
NPI:1184891210
Name:UNITED FAMILY NETWORK OF FUQUAY-VARINA
Entity type:Organization
Organization Name:UNITED FAMILY NETWORK OF FUQUAY-VARINA
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:919-749-2767
Mailing Address - Street 1:7086 KENNEBEC RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-9568
Mailing Address - Country:US
Mailing Address - Phone:919-567-1300
Mailing Address - Fax:919-331-0026
Practice Address - Street 1:7086 KENNEBEC RD
Practice Address - Street 2:
Practice Address - City:WILLOW SPRING
Practice Address - State:NC
Practice Address - Zip Code:27592-9568
Practice Address - Country:US
Practice Address - Phone:919-567-1300
Practice Address - Fax:919-331-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092-708322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children