Provider Demographics
NPI:1740474543
Name:FUNDAMENTAL HEALTH RESOURCES INC
Entity type:Organization
Organization Name:FUNDAMENTAL HEALTH RESOURCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KWAME
Authorized Official - Middle Name:KAMALA
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:BA CSAC-R QP
Authorized Official - Phone:919-539-6661
Mailing Address - Street 1:PO BOX 28887
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27611-8887
Mailing Address - Country:US
Mailing Address - Phone:919-539-6661
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:4816 LOGANSHIRE LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-2974
Practice Address - Country:US
Practice Address - Phone:919-539-6661
Practice Address - Fax:000-000-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251B00000XAgenciesCase Management