Provider Demographics
NPI:1063690246
Name:DIVERSE FAMILY SERVICES
Entity type:Organization
Organization Name:DIVERSE FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/QUALIFIED PROFESSIONAL
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:MILLISENT
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:QP
Authorized Official - Phone:919-544-5871
Mailing Address - Street 1:3020 PICKETT RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6000
Mailing Address - Country:US
Mailing Address - Phone:919-544-5871
Mailing Address - Fax:
Practice Address - Street 1:3020 PICKETT RD
Practice Address - Street 2:SUITE 135
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6000
Practice Address - Country:US
Practice Address - Phone:919-544-5871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC302E00000X302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization