1558416396 NPI number — INSTITUTE FOR FAMILY CENTERED SERVICES

Table of content: (NPI 1558416396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558416396 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:
1558416396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2024
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:
2 CENTERVIEW DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27407-3717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-297-9009
Provider Business Practice Location Address Fax Number:
336-297-0062
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODENBERG-ROBERTS
Authorized Official First Name:
MARY
Authorized Official Middle Name:
PATRICIA
Authorized Official Title or Position:
VP & SR ASST GENERAL COUNSEL
Authorized Official Telephone Number:
952-836-2234

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: 8300201 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300201B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300201H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6005645 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300201G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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