Organization
LUTHERAN FAMILY SERVICES IN THE CAROLINAS
Active
Parent organization
LUTHERAN FAMILY SERVICES IN THE CAROLINAS
Other names
Wilson Smith Cottage
Organization subpart
Yes
Provider details
NPI number
Legal business name
LUTHERAN FAMILY SERVICES IN THE CAROLINAS
Authorized official
MR. KIRBY NICKERSON (CHIEF FINANCIAL OFFICER)
(704) 754-8228
Entity
Organization
Contact information
Practice address
185 MARTINDALE RD, WINSTON SALEM, NC 27107-1705
(336) 785-3813
Mailing address
PO BOX 2369, SALISBURY, NC 28145-2369
(704) 754-8232
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL034045
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-034-045
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3406387
—
NC
Enumeration date
01/26/2007
Last updated
06/26/2017
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