Healthcare Provider Details

I. General information

NPI: 1093853822
Provider Name (Legal Business Name): LUTHERAN FAMILY SERVICES IN THE CAROLINAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 MARION ST
COLUMBIA SC
29201-2517
US

IV. Provider business mailing address

PO BOX 2369
SALISBURY NC
28145-2369
US

V. Phone/Fax

Practice location:
  • Phone: 803-708-5348
  • Fax: 803-708-5381
Mailing address:
  • Phone: 704-637-2870
  • Fax: 704-900-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. KIRBY NICKERSON
Title or Position: CFO
Credential:
Phone: 704-637-2870