Provider Demographics
NPI:1740312107
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:704-344-0491
Mailing Address - Fax:704-344-0493
Practice Address - Street 1:2300 SARDIS RD N STE M
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7712
Practice Address - Country:US
Practice Address - Phone:704-344-0491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY PRESERVATION SERVICES OF NORTH CAROLINA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-12
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300284Medicaid
NC8300284VMedicaid