Basic Information
| Provider Information | |||||||||
| NPI: | 1043540610 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY ALTERNATIVES, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | FAMILY ALTERNATIVES, INC. GROUP HOME # 2 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 963 | ||||||||
| Address2: | 103 NORTH ELM STREET | ||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283590963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107396624 | ||||||||
| FaxNumber: | 9107396781 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 E GERTRUDE ST | ||||||||
| Address2: | |||||||||
| City: | FAIRMONT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283401802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106287576 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2010 | ||||||||
| LastUpdateDate: | 01/05/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | OXENDINE | ||||||||
| AuthorizedOfficialFirstName: | LAVERN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9107396624 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320900000X | Y | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
No ID Information.