Provider Demographics
NPI:1447335989
Name:F.A.C.T. SPECIALIZED SERVICES, LLC
Entity type:Organization
Organization Name:F.A.C.T. SPECIALIZED SERVICES, LLC
Other - Org Name:
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:FRANKFORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-754-3638
Mailing Address - Street 1:1041 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1259
Mailing Address - Country:US
Mailing Address - Phone:919-833-2834
Mailing Address - Fax:919-755-1833
Practice Address - Street 1:120 HENDERSON DR STE A&B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5602
Practice Address - Country:US
Practice Address - Phone:910-346-3744
Practice Address - Fax:910-346-5344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL067140251S00000X
NCMHL067101322D00000X
NCMHL067133322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6604447Medicaid
NC6604445Medicaid
NC8303287RMedicaid