| Fernandez Community Center, Llc | |
|
8522 Six Forks Rd Ste 102 Raleigh NC 27615-3098 | |
| (919) 900-7438 | |
| (919) 900-7576 |
| Full Name | Fernandez Community Center, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 8522 Six Forks Rd Ste 102, Raleigh, North Carolina |
| Authorized Official Name and Position | Yanet A Fernandez (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9194491084 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fernandez Community Center, Llc 8376 Six Forks Rd Ste 104 Raleigh NC 27615-5095 Ph: (919) 900-7438 | Fernandez Community Center, Llc 8522 Six Forks Rd Ste 102 Raleigh NC 27615-3098 Ph: (919) 900-7438 |
| NPI Number | 1033465075 |
|---|---|
| Provider Enumeration Date | 07/27/2012 |
| Last Update Date | 07/21/2015 |
| Medicare PECOS PAC ID | 8123322609 |
|---|---|
| Medicare Enrollment ID | O20160203001014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033465075 | NPI | - | NPPES |
| Provider Name | Carolyn F Cordasco |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760415350 PECOS PAC ID: 2961468319 Enrollment ID: I20041207000819 |
| Provider Name | Eric Mizelle |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780737072 PECOS PAC ID: 4486619103 Enrollment ID: I20130122000339 |
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