| Fbtc Transitional Sub, Llc | |
|
1216 Mann Dr Matthews NC 28105-5512 | |
| (508) 942-3075 | |
| (508) 584-2227 |
| Full Name | Fbtc Transitional Sub, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1216 Mann Dr, Matthews, North Carolina |
| Authorized Official Name and Position | Mary Patricia Rodenberg-roberts (VP& SR ASST GENERAL COUNSEL) |
| Authorized Official Contact | 9528362234 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fbtc Transitional Sub, Llc 1216 Mann Dr Matthews NC 28105-5512 Ph: (508) 942-3075 | Fbtc Transitional Sub, Llc 1216 Mann Dr Matthews NC 28105-5512 Ph: (508) 942-3075 |
| NPI Number | 1972249274 |
|---|---|
| Provider Enumeration Date | 05/10/2022 |
| Last Update Date | 11/27/2023 |
| Certification Date | 11/27/2023 |
| Medicare PECOS PAC ID | 1951783505 |
|---|---|
| Medicare Enrollment ID | O20220729001134 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972249274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Mollie Sandler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083259600 PECOS PAC ID: 6901277094 Enrollment ID: I20230127002727 |
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