Basic Information
| Provider Information | |||||||||
| NPI: | 1750712998 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY PRESERVATION SERVICES OF NORTH CAROLINA, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PARKWAY RUTHERFORD - CST | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 759194 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212759194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043440491 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 356 CHARLOTTE RD | ||||||||
| Address2: | |||||||||
| City: | RUTHERFORDTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281392916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282877945 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2013 | ||||||||
| LastUpdateDate: | 12/04/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FREELEY | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | NC BILLING SYSTEM SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 7043440491 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.