Provider Demographics
NPI:1457520611
Name:FAMILY PRESERVATION SVCS OF NC, INC.
Entity Type:Organization
Organization Name:FAMILY PRESERVATION SVCS OF NC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NC QI & TRAINING DIR
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:LITTLE
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:828-225-3100
Mailing Address - Fax:828-225-3604
Practice Address - Street 1:3109 UNIVERSITY DR STE 100
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3703
Practice Address - Country:US
Practice Address - Phone:901-401-1151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408594Medicaid