1861547630 NPI number — INSTITUTE FOR FAMILY CENTERED SERVICES

Table of content: (NPI 1861547630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861547630 NPI number — INSTITUTE FOR FAMILY CENTERED SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE FOR FAMILY CENTERED SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861547630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3210 SKIPWITH RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
HENRICO
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23294-4443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-346-0051
Provider Business Mailing Address Fax Number:
804-346-0494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1415 HIGHWAY 54
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27707-5578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-403-0721
Provider Business Practice Location Address Fax Number:
919-419-9503
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
BRIANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
804-346-0051

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8300482H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300482B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6006403 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300482 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300482G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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