Provider Demographics
NPI:1265603146
Name:PIEDMONT FAMILY SERVICES
Entity type:Organization
Organization Name:PIEDMONT FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:SPANGLER
Authorized Official - Last Name:ECKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-482-2460
Mailing Address - Street 1:PO BOX 1297
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28151-1297
Mailing Address - Country:US
Mailing Address - Phone:704-482-2460
Mailing Address - Fax:704-487-5950
Practice Address - Street 1:824 S DEKALB ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-6182
Practice Address - Country:US
Practice Address - Phone:704-482-2460
Practice Address - Fax:704-487-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002 00353208D00000X
NC2005-003912084P0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006362Medicaid
NC6006362Medicaid