Provider Demographics
NPI:1043346273
Name:WORTHDALE FAMILY CARE
Entity type:Organization
Organization Name:WORTHDALE FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-231-9706
Mailing Address - Street 1:933 FRIAR TUCK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3634
Mailing Address - Country:US
Mailing Address - Phone:919-231-9706
Mailing Address - Fax:919-212-1179
Practice Address - Street 1:933 FRIAR TUCK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3634
Practice Address - Country:US
Practice Address - Phone:919-231-9706
Practice Address - Fax:919-212-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-092-037261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health