1144341439 NPI number — INTEGRATED FAMILY SERVICES, PLLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144341439 NPI number — INTEGRATED FAMILY SERVICES, PLLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED FAMILY SERVICES, PLLC.
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:
1144341439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 NASH ST STE E
Provider Second Line Business Mailing Address:
POST OFFICE 8114
Provider Business Mailing Address City Name:
WILSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27896-8114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-246-1009
Provider Business Mailing Address Fax Number:
252-246-9252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 NASH ST
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
WILSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-246-1009
Provider Business Practice Location Address Fax Number:
252-246-9252
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MANLEY-ROOK
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINSTRATIVE DIRECTOR
Authorized Official Telephone Number:
252-862-4411

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: 6005390 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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