Provider Demographics
NPI:1609051275
Name:JOHARI FAMILY SERVICES,LLC
Entity type:Organization
Organization Name:JOHARI FAMILY SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:JOHARI
Authorized Official - Last Name:INNISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-897-3000
Mailing Address - Street 1:511 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-5207
Mailing Address - Country:US
Mailing Address - Phone:910-897-3000
Mailing Address - Fax:910-897-3004
Practice Address - Street 1:511 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28312-5207
Practice Address - Country:US
Practice Address - Phone:910-897-3000
Practice Address - Fax:910-897-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302231Medicaid