Provider Demographics
NPI:1790016400
Name:FAMILY PRESERVATION SERVICES OF NC, INC.
Entity type:Organization
Organization Name:FAMILY PRESERVATION SERVICES 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 1:544 KIMBERLY AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2560
Practice Address - Country:US
Practice Address - Phone:828-225-3100
Practice Address - Fax:828-225-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8303028RMedicaid
NC8301588Medicaid