Provider Demographics
NPI: | 1700124336 |
---|---|
Name: | ABUNDANT FAITH MENTAL HEALTH SERVICES |
Entity Type: | Organization |
Organization Name: | ABUNDANT FAITH MENTAL HEALTH SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | BRITTANY |
Authorized Official - Middle Name: | YAVUN |
Authorized Official - Last Name: | BALDWIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 910-334-2212 |
Mailing Address - Street 1: | 4217 YOUNGSTOWN DR |
Mailing Address - Street 2: | |
Mailing Address - City: | GREENSBORO |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27405-9740 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 910-334-2212 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4217 YOUNGSTOWN DR |
Practice Address - Street 2: | |
Practice Address - City: | GREENSBORO |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27405-9740 |
Practice Address - Country: | US |
Practice Address - Phone: | 910-334-2212 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-01-16 |
Last Update Date: | 2017-04-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | |
No | 3104A0630X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances |
No | 310500000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness | |
No | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |