1528281425 NPI number — STRUCTURED FAMILY INTERVENTIONS, LLC

Table of content: (NPI 1528281425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528281425 NPI number — STRUCTURED FAMILY INTERVENTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRUCTURED FAMILY INTERVENTIONS, LLC
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:
1528281425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6011 FAYETTEVILLE RD
Provider Second Line Business Mailing Address:
SUITE 104-C
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27713-6248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-416-0800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6011 FAYETTEVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 104-C
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27713-6248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-416-0800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOCKLEAR
Authorized Official First Name:
DORIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
919-416-0800

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3418578 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3418775 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302972H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301584 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302972V , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5950736 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6008042 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302972G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302972 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302972Q , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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