Provider Demographics
NPI:1487786919
Name:NEXXUS FAMILY CARE SERVICES
Entity type:Organization
Organization Name:NEXXUS FAMILY CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JEVON
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-788-7929
Mailing Address - Street 1:PO BOX 20394
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27120-0394
Mailing Address - Country:US
Mailing Address - Phone:336-788-7929
Mailing Address - Fax:336-788-7998
Practice Address - Street 1:2175 MARY DEE LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-7587
Practice Address - Country:US
Practice Address - Phone:336-788-7929
Practice Address - Fax:336-788-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418094Medicaid