Basic Information
| Provider Information | |||||||||
| NPI: | 1831721687 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY PRESERVATION SERVICES, LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5371 PETERS CREEK RD NW | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240193849 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1020 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229805527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5402485510 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2020 | ||||||||
| LastUpdateDate: | 02/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | PARITI | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | CAROL | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS DEVELOPMENT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5406841928 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.