Provider Demographics
NPI:1194158634
Name:ACCESS FAMILY SERVICES
Entity type:Organization
Organization Name:ACCESS FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL ADDICTIONS SPEC
Authorized Official - Prefix:MS
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSHIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCASA
Authorized Official - Phone:919-890-5852
Mailing Address - Street 1:8374 SIX FORKS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5096
Mailing Address - Country:US
Mailing Address - Phone:919-890-5852
Mailing Address - Fax:
Practice Address - Street 1:8374 SIX FORKS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5096
Practice Address - Country:US
Practice Address - Phone:919-890-5852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========Medicaid