1922278043 NPI number — CAROLINA FAMILY ALLIANCE, INC.

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 1922278043 NPI number — CAROLINA FAMILY ALLIANCE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA FAMILY ALLIANCE, INC.
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:
CFA, INC.-RISE PROGRAM/PSR
Provider Other Organization Name Type Code:
5
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:
1922278043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1235 EAST BLVD
Provider Second Line Business Mailing Address:
#242
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28203-5870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-536-9378
Provider Business Mailing Address Fax Number:
704-536-9359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9105 MONROE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28270-1644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-536-9378
Provider Business Practice Location Address Fax Number:
704-536-9359
Provider Enumeration Date:
03/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MACK
Authorized Official First Name:
SABRINA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXECUTIVE DIRECTOR/OWNER
Authorized Official Telephone Number:
704-536-9378

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X , with the licence number: 060-1177 , registered in the state of NC ; 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: 6008015 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5914573 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303125 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302432 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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