Provider Demographics
NPI:1447331475
Name:F.A.C.T. SPECIALIZED SERVICES, INC.
Entity type:Organization
Organization Name:F.A.C.T. SPECIALIZED SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:QI DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-346-3744
Mailing Address - Street 1:109 SILVERLEAF DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7360
Mailing Address - Country:US
Mailing Address - Phone:910-353-1903
Mailing Address - Fax:910-577-4568
Practice Address - Street 1:109 SILVERLEAF DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7360
Practice Address - Country:US
Practice Address - Phone:910-353-1903
Practice Address - Fax:910-577-4568
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE METHODIST HOME FOR CHILDREN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-18
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL067133322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603236Medicaid