Provider Demographics
NPI:1972249274
Name:FBTC TRANSITIONAL SUB, LLC
Entity type:Organization
Organization Name:FBTC TRANSITIONAL SUB, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP& SR ASST GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:RODENBERG-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-836-2234
Mailing Address - Street 1:1216 MANN DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5512
Mailing Address - Country:US
Mailing Address - Phone:508-942-3075
Mailing Address - Fax:508-584-2227
Practice Address - Street 1:1216 MANN DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5512
Practice Address - Country:US
Practice Address - Phone:508-942-3075
Practice Address - Fax:508-584-2227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FBTC TRANSITIONAL SUB LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health