Provider Demographics
NPI:1811342488
Name:F&J COMMUNITY SERVICES, INC.
Entity type:Organization
Organization Name:F&J COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FANNIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:CLYBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-475-4643
Mailing Address - Street 1:128 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-8106
Mailing Address - Country:US
Mailing Address - Phone:704-475-4643
Mailing Address - Fax:
Practice Address - Street 1:7612 US HIGHWAY 52 S
Practice Address - Street 2:
Practice Address - City:MORVEN
Practice Address - State:NC
Practice Address - Zip Code:28119-8312
Practice Address - Country:US
Practice Address - Phone:704-475-4643
Practice Address - Fax:704-851-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL000000251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services